Daily Kos: Sebelius extends offer to Texas on Medicaid, Texas doesn’t care

Posted by:  :  Category: Medicare

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Texas, however, isn’t interested. “With due respect, the secretary and our president are missing the point: It’s not that Americans don’t understand Obamacare, it’s that we understand it all too well,” Gov. Rick Perry said in a statement on Sebelius’ visit to Texas. He added that Texas refused to set up a state-run exchange or expand Medicaid in order to minimize the damage that the law would cause to the economy and state budget, “although we’re all too aware Obamacare will still cause our state immense budgetary challenges in the years ahead, just like it will to families and small businesses across our country.” So, working poor people in Texas, your governor says, basically, “fuck you.” Just because he hates Obama.
Source: dailykos.com

Video: 7 Accused of Bilking $375M From Medicare

Ways to prevent Medicare fraud in Texas before it occurs

Strong evidence indicates that isolated pockets of home health providers are abusing the Medicare program. Analyses show, as detailed in your article, Texas is home to high levels of aberrant behaviors. In fact, just 18 of Texas’ 254 counties are responsible for more suspected home health fraud and abuse than any single state nationwide.
Source: dallasnews.com

Texas Health Resources, physician group withdraw from Medicare’s Pioneer ACO program

The hospital and North Texas Specialty Physicians are partners in Plus ACO, an accountable care organization that joined the Medicare Pioneer ACO program in December 2011. Accountable care organizations are intended to accept financial responsibility for Medicare beneficiaries’ healthcare and share in any losses or savings their patients accrue.
Source: medcitynews.com

Bexar County Texas Medicare Supplement Quotes

Tagged With: Aetna Medicare, Aflac Medicare, Bache, Bexar County Medicare, Bexar County Medicare Supplement Insurance, Bexar County Texas Medicare Supplement Insurance, Cigna Medicare, Medicare, Medicare Quotes, MedicareBob, Medigap, Mutual of Omaha Medicare, Robert Bache, Senior Healthcare Direct, Texas Medicare, www.SrHealthcareDirect.com
Source: srhealthcaredirect.com

Planned Parenthood Gulf Coast to Pay $1.4 Million in Texas Medicare Fraud Settlement

A whistleblower lawsuit was filed against Planned Parenthood Gulf Coast which alleged improper billing practices. The State’s investigation revealed that the group improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and not covered by the Medicaid program.
Source: kfyo.com

Texas man sentenced for Medicare scam

Prosecutors say Kimble operated four ambulance companies in the Houston area from 2008 to 2010. He routinely billed the federal Medicare program for ambulance transports that were not provided, not needed or not ordered by a treating physician.
Source: ems1.com

CMS Clarifies Medicare Requirements Regarding Progress Notes and Templates, and Corrections and Delayed Entries in Medical Records

Posted by:  :  Category: Medicare

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In Transmittal 438 (Change Request 8033 (Nov. 9, 2012)), CMS revised Medicare Program Integrity Manual (100-08), Chapter 3, Section 3.3.2.1.1, “Progress Notes and Templates,” effective December 10, 2012, to define “Progress Notes” and “Template” for medical record documentation purposes. This transmittal also includes guidelines regarding the documents that Medicare contractors are to consider in making pre-payment and post-payment determinations. Review contractors must now consider all permanent medical record entries, including those entries created using limited space templates and should extract any usable information relevant to the claim made by the treating practitioner. In Transmittal 442 (Change Request 8105 (Dec. 7, 2012)), CMS provides instructions to Medicare contractors regarding amended, corrected, and delayed entries in medical records. These instructions provide that Medicare contractors are to consider all submitted medical record entries that comply with certain principles described in the transmittal. These instructions will revise, effective January 8, 2013, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.5, “Amendments, Corrections and Delayed Entries in Medical Documentation.” The transmittals are available here and here.
Source: nortonrosefulbright.com

Video: Does the Original Medicare Plan Pay for Mental Health Care?

USP’s Draft Revisions To Medicare Formulary Guidelines Coming In September :: “The Pink Sheet” :: Elsevier Business Intelligence

In addition to their use as a reference for Medicare Part D plans, the current guidelines serve as a benchmark for evaluating the formularies of private insurance plans offered through state exchanges.
Source: elsevierbi.com

Preserving Medicare for Future Generations: Market

America’s fee-for-service Medicare program represents the third-largest category of federal spending and has been under scrutiny for decades for spending more on health care benefits for enrollees than taxes can generate to pay for them. The CBO estimates that over the next 10 years, the number of Medicare enrollees will increase by one-third—approaching 67 million Americans.
Source: rwjf.org

Rural Resources on Medicare Part D Prescription Drug Benefit Introduction

Medicare Part D is the prescription drug benefit added to Medicare in 2006. It was created through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and provides elderly and disabled people on Medicare access to prescription drug coverage from private prescription drug plans.
Source: raconline.org

Eastern Group Publications

Twenty-two people named in two federal grand jury indictments outlining an alliance between the Mexican Mafia prison gang, a South Los Angeles street gang and a drug cartel were arrested Tuesday in a series of Southern California raids. The crackdown is being hailed as a major… [Read more…]
Source: egpnews.com

How Entrepreneurs Could Solve Medicare’s Problems

There are numerous examples of islands of excellence (Mayo, Intermountain Healthcare, Cleveland Clinic and so forth) on the supply side of the health care market. Their success is often the result of the efforts of a few individual entrepreneurs. However, there is little incentive for other health care providers to copy their successes because there is no penalty for low-quality, high-cost providers when Medicare (or Medicaid) is paying the bills. On the demand side, government, nonprofit foundations and private insurers have sponsored a slew of pilot programs, such as pay-for-performance and others, designed to lower costs, increase access and improve quality. But these efforts have not produced measurable results. In fact, there is no single institution providing high-quality, low-cost care that was created by any demand-side buyer of care. Not the Centers for Medicare and Medicaid Services (CMS), which runs Medicare and Medicaid. Not Medicare. Not BlueCross. Not any employer. Not any payer, anytime, anywhere.
Source: ncpa.org

Examples of Taxpayers Facing Medicare Tax Increase under Health Care Bill

The health care bill passed by the House of Represenatives on Sunday (Senate bill plus reconciliation) includes, among many other tax increases, two tax hikes on high-income taxpayers set to go into effect in 2013. One of the increases is a higher employee Medicare tax on wages earned above $250,000 (married; $200,000 for singles). The other tax hike is a 3.8 percent Medicare tax on investment income earned by couples earning more than $250,000 in modified adjusted gross income ($200,000 for singles). Investment income includes such sources as rental income, dividend income, interest income, income from trusts, and most capital gains.
Source: taxfoundation.org

Bricker & Eckler LLP, Please try again

We have recently redesigned our website! As we continue to improve the content of our site, we appreciate your patience as certain pages may be temporarily unavailable or moved. May we assist you in your search? The links below might be helpful in locating information:
Source: bricker.com

The Cost of Privatization: Extra Payments to Medicare Advantage Plans

The Medicare Modernization Act of 2003 sharply increased payments to private Medicare Advantage plans. As a result, every plan in every county in the nation was paid more in 2005 than its enrollees would have been expected to cost if they had been enrolled in traditional fee-for-service Medicare. The authors calculate that payments to Medicare Advantage plans averaged 12.4 percent more than costs in traditional Medicare during 2005: a total of more than $5.2 billion, or $922 for each of the 5.6 million Medicare enrollees in managed care. This issue brief updates an earlier analysis of Medicare Advantage payments in 2005 previously published by The Commonwealth Fund; the updated estimates in this report are based on final 2005 enrollment figures that were not available at the time the previous estimates were developed, and they include the effect of policy decisions that were not reflected in the previous estimates.
Source: commonwealthfund.org

The Impact of Medicare Part D on Out

After adjusting for sociodemographic characteristics and health status, compared to the near-elderly group, they found that Medicare Part D beneficiaries had a $179.86 reduction in out-of-pocket costs and a 2.05 increase in the number of prescriptions between 2005 and 2006. There was no significant change in emergency department use, hospitalizations, or preference-based health utility that would suggest a cost offset.
Source: rwjf.org

Medicare covers home health services

Skilled nursing services are given by either a registered nurse or a licensed practical nurse under an RN’s supervision. Nurses provide direct care and teach you and your caregivers about your care. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care.
Source: zemax.tv

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

Posted by:  :  Category: Medicare

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It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: healthaffairs.org

Video: Medicare Changes in 2013 by 1-800-MEDIGAP®

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

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

Medicare changes threatening to shut down local suppliers

“I am disheartened to see the implementation of a program which would force our area small businesses to lay off employees and potentially close their doors at a time when our economic recovery depends on their success,” Forbes said in a statement last week. “Many small business owners in the [Durable Medical Equipment] industry have personally expressed their concern to me that the process, as it stands, has created rates which are untenable for a small business to operate.”
Source: medbill.net

Medicare Changes in Mail Order Testing Supplies

The article discusses mail-order Diabetes Testing Supplies, and how the rules have changed as of July 1. There are now just 18 Medicare suppliers for them, depending on your zip code and the type of test strip you use. After reading the above article, I called my (former) supplier, who said I’d have to pay for my supplies out-of-pocket if I continued to use them! Then I called Medicare and I got a list of possible Medicare suppliers in my zip code who would send to me my brand of test strips.
Source: tudiabetes.org

Proposed Payment Changes for Medicare Home Health Agencies

Medicare pays home health agencies through a prospective payment system, which means that Medicare pays a fixed or base amount for a particular service that is adjusted based upon the health condition and needs of the beneficiary (i.e. case mix) and differences in wages.  The case mix factor allows Medicare to pay higher rates for services that are provided to beneficiaries with the greatest needs. Payment rates are based on patient assessment data collected by Medicare participating home health agencies.
Source: mcbrayerhealthcare.com

Sex Change Surgery Won't Be Covered By Medicare, U.S. Says

However, the surgery has become commonplace after more than three decades in the medical mainstream, with the American Medical Association in 2008 supporting “public and private insurance coverage” for treatment of the disorder. Presently, psychologists and physicians use the diagnosis for patients who experience significant “gender dysphoria,” a profound dissatisfaction with either their sex or sex assignment at birth or during early childhood. Defined as a medical condition in the medical profession’s Diagnostic and Statistical Manual, Version IV, the disorder involves symptoms related to transsexualism.
Source: medicaldaily.com

Medicare Advantage Changes: Why You May Pay More for Less

Sure, the MAOs could lower quality but at a risk of losing needed bonuses, but the needed funds to maintain operations could be found by reducing benefits and service area. This is a crucial factor for beneficiaries to be aware of.  Still, with the possibility of increased premiums and fewer benefits there is potential for many plan exits. As the healthy people who do not need to pay much for health insurance start to drop their plans the ill or chronically ill people that need the plans and derive benefit from them will stay. This is underscored as the most formidable flaw of the ACA, and could pose as a problem for the health care system.  Because of the increases in beneficiary cost sharing and beneficiary premiums it is predicted that people with lower incomes and people that are more likely to need medical care, such as for a chronic condition, are most likely to be adversely affected by the changes. People needing frequent medical care are expected to be paying higher premiums. It is said that services such as dental and over the counter medication coverage will most likely not be in the future of the MAOs.
Source: bhmpc.com

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August 13, 2013

Viewpoints On Medicare: Advantage Program Offers Roadmap To Improving The Program; Rare Bipartisan Support For Doctor Pay Fix

Posted by:  :  Category: Medicare

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Bloomberg: Retirees’ Medical Bills Are Bringing Down Detroit The emergency manager in charge of keeping Detroit afloat says the city’s $20 billion debt load can’t be reduced to manageable levels without “shared sacrifice” from all stakeholders, including retirees. Pension and retiree-health-care obligations make up the bulk of the city’s unsecured debt, and their costs are rising rapidly. The emergency manager, Kevyn Orr, is right that Detroit must reduce its retirement-related debt to secure its future, but he has to be more specific about his target. Cutting retiree health care — also referred to as “other post-employment benefits,” or OPEBs — should take priority over pensions (Stephen Eide, 7/2).
Source: kaiserhealthnews.org

Video: What Is Medicare Advantage?

Medicare Advantage defies the forecast with rapid growth

Advantage plans, which combine Part A (hospitalization) Part B (outpatient services) and usually Part D (prescription drugs), are on a big-time roll. Enrollment has jumped an impressive 10 percent in each of the past three years, according to data compiled by the Kaiser Family Foundation (KFF), a non-profit healthcare research and policy organization. About 28 percent of all Medicare enrollees this year are in an Advantage plan.
Source: retirementrevised.com

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: kff.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

Is a Medicare Advantage Plan Right for Me?

Standard Medicare insurance typically pays for all necessary medical expenses for individuals who are old enough to receive Medicare or for those who have a disability. However, this sometimes forces patients to find a new physician that will accept Medicare. Medicare Advantage eliminates many of these hurdles because the benefits are paid directly to the private insurance company as part of the monthly premium. This eliminates the problem of having to find a medical facility that accepts Medicare. However, it also means that the patient may have to pay additional premiums and co-pays. They are responsible for co-pays just as they would be if they did not have Medicare insurance at all. Moreover, they are also responsible for any additional monthly premiums that is beyond the amount which is covered by Medicare.
Source: askamydaily.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

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August 13, 2013

Compare Medicare Supplement Plans Online

Posted by:  :  Category: Medicare

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One final thing to think about when looking at Medigap coverage is your out-of-pocket limit. This is also something that is going to differ from one policy to another. In most cases, the Medigap policy is going to cover 100% of the services that are necessary once you have reached your annual out-of-pocket limits. This is something that should be considered carefully, especially if the time comes when you need regular care.
Source: thinkitout.net

Video: Resetting Medicare Online Services password and secret questions – for existing customers

Petitions Help Bring the Voices of Americans into Social Security, Medicare Discussions

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment and income security, retirement planning, affordable utilities and protection from financial abuse. We advocate for individuals in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www.aarp.org; AARP TV & Radio; AARP Books; and AARP en Español, a Spanish-language website addressing the interests and needs of Hispanics. AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Doctors Refuse To Accept Medicare Patients

California Healthline says that physicians have several reasons for opting out of the program. Most significant, though, are the low reimbursement rates, concerns about patient privacy, and unhappiness with the government’s increasing involvement in medicine. As far as the increased government presence goes, Becker’s Hospital Review cites the penalties for physicians who do not demonstrate Meaningful Use through EHRs as an example. The WSJ also says that doctors recognize that Medicare payment rates have not kept up with inflation, and that there are dangers of more cuts in the future.
Source: healthcaretechnologyonline.com

Medicare Health Professional News

Better Access aims to improve outcomes for people with a clinically-diagnosed mental disorder through evidence-based treatment. Under this initiative, Medicare benefits are available to patients for selected mental health services.
Source: gov.au

Medicare Online Enrollment

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

Medicare Rules Changed July 1 » Toni Says

The new mail-order program does not require you to change the particular testing monitor, test strips and lancets you currently are using. Remember, Medicare only wants you to use the mail-order supplier that they approve.  If you are happy with the monitor, test strips and lancets you are currently using, you will want to use a competitive bidding supplier that stocks your testing items. You will need to provide your new supplier with either a new prescription for your diabetic supplies or have your current prescription transferred. Talk to your doctor about a new prescription.
Source: tonisays.com

Railroad Medicare is Part B Medicare for retirees

If a provider or supplier you want to work with participates in Medicare, but states “not Railroad Medicare,” Palmetto GBA recommends that they call Palmetto’s Provider Contact Center at (888) 355-9165. Palmetto’s staff is trained to discuss these matters with all Part B providers and suppliers. They also recommend providers or suppliers visit Palmetto’s website at www.PalmettoGBA.com/RR.
Source: utu.org

Rock Hill Herald Online Rock Hill, SC

Unfortunately, we are unable to locate the page you have requested. This could be due to content on our site having expired, a broken link, an outdated bookmark, or a mistyped address. Please use the site map provided on this page.
Source: heraldonline.com

Social Security and Medicare Should Not Be Used to Reduce Deficit

Crack down on waste and inefficiency: The U.S. health care system wastes as much as one-third of all spending because of inefficient payment systems, uncoordinated care, mistakes, duplication and unnecessary paperwork. We must step up efforts to detect fraud and crack down on criminals who file false Medicare claims. We need to focus on improving care and cutting unnecessary tests and procedures, which are often the result of payment incentives and fear of litigation.
Source: aarp.org

Medicare gives hospital 90 days to shape up

In its letter, the federal agency said nursing, laboratory, food, anesthesia and respiratory services were deficient. The hospital’s infection control and physical environment for patients weren’t adequate. Also, federal, state and local laws weren’t followed.
Source: lubbockonline.com

Top 10 Online Resources for People on Medicare

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

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August 13, 2013

Medicare: MSPRC New Address & Fax

Posted by:  :  Category: Medicare

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This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

Video: Obama Disputes Romney, Ryan Medicare Claims

Blue Jersey:: News Roundup and Open Thread for Friday, August 2, 2013.

» Alicia Menendez » Alive and Kickin » Baristanet » Blog the Fifth » Capitol Quickies » The Center of NJ Life » Channel Surfing » Channel Surfing » Deciminyan » The Englewood Report » Frank Lobiondo Record » Fred Snowflack » Freedom to Tinker » Garden State Grapevine » ClearysNoteBook » Herb Jackson » Hoboken Journal » Hoboken Now » Jersey Blogs » Jersey Jazzman » Middletown Mike » More Monmouth Musings » NJ Domestic Partnership » NJ Politics Unusual » NJ Voices: Policy Watch » On Our Radar » The Opinion Mill » Other Spaces » Plainfield Plaintalker » PolitickerNJ » Retire Garrett » Ruins of Trenton » Senator Ray Lesniak » Stovetop Diplomacy » Sustainable Cherry Hill » The Subversive Garden » Teaneck Progress » Trenton Kat » We Don’t Need Permission » Xpatriated Texan
Source: bluejersey.com

Chairman Carper, Ranking Member Coburn Introduce Bipartisan Postal Reform Bill

Chairman Carper said: “One year ago, the United States Postal Service defaulted for the first time in its history. As Businessweek put it: ‘The U.S. Postal Service essentially went broke today.’ The agency was – and is – facing its worst financial challenges in 200 years. Over the past year, Americans have realized the hard truth that the Postal Service is on the verge of financial collapse. If it were to shut down, the impact on our economy would be devastating. Although the situation is dire, it isn’t hopeless. With the right tools and quick action from Congress, the Postal Service can reform, right-size and modernize. The bill that Dr. Coburn and I introduced last night presents a comprehensive and bipartisan solution to the Postal Service’s financial challenges that would prevent collapse, protect millions of mailing industry jobs, and enable this critical institution to serve the American public for years to come. This bill isn’t perfect and will certainly change as Dr. Coburn and I hear from colleagues and stakeholders, including postal employees and customers. But the time to act is now. It is my hope that Congress and the Obama Administration can come together to enhance this plan in order to save the Postal Service before it’s too late.”
Source: ruralinfo.net

Weekly Update: New Electronic Mailing List to Keep Medicare Fee

Announcements on items such as the International Classification of Diseases, 10th Edition (ICD-10), the Electronic Health Record (EHR) incentive programs, Medicare enrollment, the Medicare Shared Savings Program, and new regulations; 
Source: blogspot.com

Have You Updated All of Your Addresses with Medicare The Consequences of Not Doing So Are Severe

Tag words:  Medicare, Medicare audits, Medicare site visits, termination of Medicare billing privileges, Centers for Medicare & Medicaid Services (CMS), corrective action plan (CAP), request for reconsideration, Medicare administrative hearing, administrative law judge(ALJ), physicians, medical groups, medical practices, clinic, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers, Medicare Administrative Contractors (MAC), Zone Program Integrity Contractors (ZPIC), ZPIC site visit, ZPIC audit, fraud prevention, Medicare number revocation, Medicare termination, OIG special agents, Medicaid Fraud Control Unit (MFCU), investigators, Medicare Provider Enrollment Chain and Ownership System (PECOS), National Plan & Provider Enumeration System (NPPES), NPI Registry
Source: thehealthlawfirm.com

Are Medicare Supplement Companies Regulated?

Medicare supplement companies are regulated by the Federal Trade Commission for example. The Medicare supplement companies are going to try to sell you things once you become Medicare eligible. The things that they sell you can be traditional medical devices or things like unique pacemakers for example which fit your exact medical needs. A consumer has to make sure that the companies trying to sell you devices that they try to sell you these devices in an honest way. The Federal Trade Commission wants to make sure that if companies get your mailing address that the Medicare supplement companies do get your address in a very legal way.
Source: seniorcorps.org

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August 13, 2013

Compare Medicare Supplement Plans Online

Posted by:  :  Category: Medicare

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One final thing to think about when looking at Medigap coverage is your out-of-pocket limit. This is also something that is going to differ from one policy to another. In most cases, the Medigap policy is going to cover 100% of the services that are necessary once you have reached your annual out-of-pocket limits. This is something that should be considered carefully, especially if the time comes when you need regular care.
Source: thinkitout.net

Video: Medicare Supplements – 5 Things To Know Before You Buy A Medicare Supplemental Policy

HHS Inspector General Raises Concerns About Medicare Policy On Observation Care

Boston Globe: Beth Israel Deaconess Settles With US For $5.3m Faced with government allegations of improper billing, Beth Israel Deaconess Medical Center paid $5.3 million Monday to settle claims that it overcharged Medicare by admitting patients who should have been treated less expensively as outpatients. The allegations involved patients who were admitted to the Harvard teaching hospital for brief stays between 2004 and 2008 and who were suffering from congestive heart failure, chest pain, gastroenteritis, and nutritional and metabolic disorders, federal officials said in a written statement (Kowalczyk, 7/30).
Source: kaiserhealthnews.org

Beneficiaries Left with Limited Mobility Due to Medicare Policies Restricting Power Wheelchair Repairs

In order to be reimbursed for repairing power wheelchairs, CMS requires companies to collect the documentation of medical necessity that was originally submitted when the beneficiary was approved to receive the equipment. That becomes a problem, Letizia said, when the supplier who provided the equipment is out of business and there is no access to the paperwork. “In those cases, CMS wants providers to go to the doctor and get the documentation from them. Good luck with that,” said Letizia, who is also president of Laurel Medical Supplies, Inc. in Pennsylvania.
Source: disabled-world.com

Already on Medicare? Don’t worry about the new health insurance exchanges

Those of you on Medicare may also decide to purchase a supplemental insurance policy, referred to as a Medigap policy. It is sold by private insurance companies to fill in the gaps in Original Medicare coverage. It pays some of the health care costs that Original Medicare does not cover. If you are on Medicare and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Source: everydayfinancialplanner.com

Utah Medicare Supplements

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Hey David Suzuki, Canada is not full and your policies would kill Medicare

The dangerous fall in the birth rate, a consequence of abortion and contraception, has directly decreased the ratio of workers (who pay taxes) per pensioner (who receives taxpayer-funded medicare, OAS, etc). That ratio has been decimated since 1966.  In 1970 for example, Canada had almost 6-1/2 workers per pensioner. Today there are barely 4 workers per pensioner.  The decline represents a roughly 38% reduction in the number of future workers. By 2030 the ratio is projected to be approximately 2.5 workers per pensioner. This means that our universal health care system (i.e. Medicare) and public retirement income systems are unsustainable. It is a major economic and social crisis which immigration alone cannot solve.
Source: lifesitenews.com

Medicare Fee Schedules Must Be Disclosed in PIP Policies

This issue was certified to the Florida Supreme Court by the Third District Court of Appeals (“3rd DCA”) after noticing that similar issues were being raised in Florida courts statewide. The initial decision by the 3rd DCA was consistent with the other districts which have already decided on such issues. The Florida Supreme Court decision affirmed the decisions of all the DCAs that PIP insurance providers must notify policyholders by an election in their policy if they plan to use Medicare-based fee schedules.
Source: flpipguide.com

Understanding the Third Piece of the Core Medicare Payment: The “Backstop”

Over time, some policymakers have targeted these “backstop” payments as part of a larger focus on Medicare hospital spending for budget savings.  Those who propose reducing or eliminating these payments note that private payers typically do not reimburse hospitals for unpaid patient cost-sharing, and assert that the government should adopt similar policies.  However, this rationale ignores a fundamental difference between Medicare and private insurance. Under Medicare’s fixed price system, the government determines both the amount Medicare pays and the amount of the cost-sharing responsibility of the patient.  Private insurers and hospitals, however, establish payment rates through negotiation, which enables them to account for inevitable unpaid cost-sharing from policyholders.  Absent this ability to negotiate, a “backstop” under Medicare helps ensure full payment for hospital services to seniors when they are unable to pay the cost-share amount set by the government.
Source: fahpolicy.org

Medicare Savings: Cut Benefits to the Elderly or to Big Pharma's Windfall Profits?

The Ryan plan would change Medicare from a guarantee of health care (with associated premiums, co-payments, and deductibles) to a "premium support" program. In other words, it would be a voucher program – the voucher being a flat payment given to beneficiaries to obtain either Medicare coverage or to buy a private insurance policy. This would increase costs significantly for Americans because annual increases in the amount of this voucher would likely fail to keep pace with the growth in health care costs from year to year. Thus, beneficiaries would have to pay increasingly more out of their own pockets for insurance coverage, either through Medicare or from private insurers.
Source: foreffectivegov.org

San Diego Medicare Agency Comments on Denied Medicare & What to Do

Understand your doctor’s classification. If your doctor “accepts assignment,” you’ll likely have to pay the annual Medicare Part B deductible and a 20% copay per visit. That’s the ideal situation for most Medicare policies. However, if you have a non-participating doctor, he or she may still accept Medicare but not quite under the prescribed reimbursement amounts. A non-participating doctor can charge a patient up to 15% over the Medicare-approved amount. However, a Medigap insurance policy can take care of these extra costs – call us at 619-934-7227 to discuss selecting a Medigap policy in addition to your current Medicare coverage.
Source: pomeradonews.com

The other Washington could hold the key to Medicare's cost crisis

 But in Washington state, which is known for its progressive politics, the measure, requested by former Democratic Gov. Christine Gregoire, sailed through the legislature, albeit with an appeals process amendment the governor vetoed. “Medicare should be doing this, but it gets rolled by the Congress,” said Dr. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission (MEDPAC), an independent agency that advises Congress on issues affecting Medicare. Berenson pointed to several high-profile examples of Congress meddling with coverage policy, including the case of the late Sen. Ted Stevens of Alaska, who at the behest of the PET scan industry almost single-handedly forced Medicare to cover the scan as a test for Alzheimer’s, a policy that existing science did not support.
Source: publicintegrity.org

CMS Seeks Input on Disclosure of Individual Physicians’ Medicare Payments

HHS still has a policy regarding the release of individual physician data, which it adopted in 1980. It states that “the public interest in the individuality identified payment amounts is not sufficient to compel disclosure in view of the privacy interests of the physicians.” But given the recent court decision to vacate the 1979 injunction, CMS is now seeking public input on whether and how to modify its 1980 policy.
Source: beckershospitalreview.com

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August 13, 2013

More Physicians No Longer Seeing Medicare Patients

Posted by:  :  Category: Medicare

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Efforts to contain Medicare spending may show signs of being a double-edged sword.  You can’t arbitrarily cut provider payment rates without consequences.  It seems one consequence is driving more doctors away from Medicare at the time Medicare’s population is growing.  Health leaders advocate market-based, consumer-centered incentives that drive both higher quality and cost containment without subjecting providers and patients to harsh situations.
Source: hlc.org

Video: FBI and HHS lead Medicare Fraud Bust in metro Detroit

Social Security and Medicare tax rates

Alabama    Alaska    Arizona    Arkansas    California    Colorado  Connecticut    Delaware    Florida    Georgia    Hawaii    Idaho    Illinois    Indiana    Iowa    Kansas    Kentucky    Louisiana    Maine  Maryland    Massachusetts    Michigan    Minnesota    Mississippi    Missouri   Montana    Nebraska    Nevada    New Hampshire    New Jersey    New Mexico    New York    North Carolina    North Dakota    Ohio    Oklahoma    Oregon    Pennsylvania    Rhode Island    South Carolina    South Dakota   Tennessee   Texas    Utah    Vermont    Virginia    Washington    West Virginia    Wisconsin    Wyoming
Source: socialsecurityoffices.us

Centegra welcomes new Medicare Part B participants

After the first year, Medicare participants can get a yearly wellness visit for free. This comprehensive visit includes a review of medical history, preventive tests and screenings and planning for a healthy future. Participants who need a primary care physician or whose physician does not perform this special exam may call Centegra at (815) 338-6600 to schedule an appointment. Those who have participated in Medicare Part B for more than 12 months may utilize the new Yearly Wellness Exam, which is available to participants every 12 months. Participants of the Welcome to Medicare Exam must wait 12 months before taking part in the Yearly Wellness Exam.
Source: centegra.org

How Do You Get Medicare Part D?

As the nation’s largest drugstore chain with fiscal 2012 sales of $72 billion, Walgreens (www.walgreens.com) vision is to become America’s first choice for health and daily living. Each day, Walgreens provides more than 6 million customers the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice in communities across America. Walgreens scope of pharmacy services includes retail, specialty, infusion, medical facility and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers and the public sector. The company operates 8,077 drugstores in all 50 states, the District of Columbia and Puerto Rico. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health and wellness centers and in-store convenient care clinics, with more than 700 locations throughout the country.
Source: womanaroundtown.com

Hospitals Attempt to Reduce Medicare Readmission Rates

Enter Project BOOST (Better Outcomes for Older adults through Safe Transitions), a research-driven initiative aiming to assist hospitals reduce their readmission rates. This is done by attempting to identify all patients who present the highest risk of being readmitted. BOOST creates a discharge strategy that ideally would ease their transition from inpatient care back to regular living. In these instances, Project BOOST’s approach is to schedule a series of follow-up phone calls and doctors’ appointments with patients to ensure a reduction in complications.
Source: ehealthmedicare.com

CMS Awards Round 2 Medicare Contracts to Medical Suppliers

AAHomecare AARP Almost Family Almost Family Inc. Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Brookdale Senior Living Care.com CellTrak Technologies Inc. Center for Medicare & Medicaid Services Centers for Medicare & Medicaid Services CliftonLarsonAllen CMS Department of Justice Emeritus Senior Living featured Federal Bureau of Investigation Gentiva Health Services Inc. HHS Home Health Depot Home Health International Humana IntegraCare Jordan Health Services Kindred Healthcare Kindred Healthcare Inc. LHC Group LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare Partnership for Quality Home Health Care PHI Quantum Home Care Inc. ResCare HomeCare Scripps Health Sentara Healthcare The Partnership for Quality Home Healthcare VA Visiting Nurse Association
Source: homehealthcarenews.com

Health Care Clinic Director Pleads Guilty in Miami for Role in $63 Million Health Care Fraud Scheme

HCSN also operated one location in Hendersonville, N.C. At the Hendersonville location, Layman served as the clinical director and assisted HCSN owner Armando Gonzalez in obtaining necessary licensing, credentials and Medicare authorizations for HCSN. According to court documents, from 2008 through 2009, Layman purportedly supervised therapists at HCSN in Hendersonville, including Alexandra Haynes, who was an unlicensed therapist purportedly performing PHP therapy to HCSN patients. For their roles in the conspiracy, Gonzalez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, and Haynes pleaded guilty to one count of conspiracy to commit health care fraud. On Monday, Feb. 25, 2013, Gonzalez was sentenced to serve 168 months in prison for his role in the scheme.
Source: phiprivacy.net

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August 13, 2013

Part D Formulary Is Key To Choosing The Right Plan

Posted by:  :  Category: Medicare

My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???
Source: affordablemedicareplan.com

Video: Medicare Part D Formulary

Humana Walmart Prescription Rx Plan

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
Source: qooqe.com

Medicare Part D, formularies, competition, pricing leverage and getting it all wrong

Medicare Part D has long presented a controversy because the law prevents direct negotiation by the government with drug companies for lower prices and rebates; something common in the private sector via pharmacy benefit managers (PBMs). Rather, each Part D provider must negotiate on its own, but with so many vendors offering Part D benefits their negotiating power is limited. In New Jersey for example there are eighteen different vendors offering Part D plans to 1,336,988 Medicare beneficiaries. That is an average of less than 74,277 individuals per vendor (some beneficiaries have private drug coverage through previous employers). How much more pricing leverage would there be if there were only three or four Part D insurers in NJ (or nationally)? In addition, these vendors are prevented from limiting their formulary drugs.
Source: quinnscommentary.com

medicare supplemental insurance comparison: it is medicare formulary finder

Nobody can be no healthy problem in his life. Ill condition infulences the charge a lot. So far, people are insterested in medical treatment insurance. A long time ,people hesitate go or not go to hospital ,but now ,they don’t,cause they have medical treatment insurance. Look ,the medical has no shortage, only is good for all the people.. i like medical insurance because it could give us more happyness and safety once you get sick you can ask your insurance company for part of your money expense or even all your medical expense. you know unexpected emergencies happen like car accidents, unexpected injuries and serious dieases. the medical could save most part of the money and help people give them a hand. medical insurance plays a key rule for the old people who has no children and give them free treatment. The health care insurance coverage that beared with the place out division has benefited most males and females in most countries. We choose commercial health insurace companies to get more services. There are many notes we should follow. The company is legally registered or not. It is very important weather the company has enough money to pay for accident insurance or not. Does the company has a high integrity? By the way, both the company’s health insurance products and insurance costs are taken into think. According to the survey ,it’s about 90% of Americans are enjoying the new medical insurance that the government adopted in 2010. The introduction of the new medicare insurance benefit for most Americans, and increased the confidencethe index of people living. Finland has also just adopted a new medical insurance reform program. Good medical insurance is one of the government reliability standards which people evaluate their government.
Source: blogspot.com

medicare supplement insurance: WTO for people offers medicare formulary

Hosptial-in wanted by many people who have many healthy problems in their life. We are not sure what ll condition is and how much it costs. So far, people are insterested in medical treatment insurance. People can choose the hosptial whatever is expensive,cause they have medical treatment insurance. Do not say we could live without it. do you like happyness and feel more security? i think medical insurance is something you shoud do. there are very good point that medical insurance company will give you medical expense if you have any problem of your body. it is very important for family and the person. because of if uncertain things happen ,such as accident harm, major disease, medical insurance will give you security for your medical expense or even pay all your money. For some elderly people without children, medical insurance, but also played a decisive role, allowing them the free treatment. In a tremendous amount of nations, the federal government division has beared the health care insurance. In order to get more services, we choose some commercial companies to buy medical insurance. There are a lot we should care about. Weather the company has been recognized by Insurance Regulatory Commission or not? We must acquire obvious the company’s payment capacity. Does the company has a high social reputation? As well as, both the company’s popularity and the company’s scale are taken into consideration. 95% of people in the United States in 2010 enjoy the new medical insurance program which the United States government adopted. The introduction of the new medical insurance make the living confidence index of Americans soared. Italy also has just adopted a new medical insurance reform plan. The good medical insurance system in the country is an important guarantee for people’s stability lives.
Source: blogspot.com

Medicare Part D Guidance: Medication Therapy Management, Formulary Submissions : Health Industry Washington Watch

In addition, CMS has issued guidance to Part D plan sponsors on the process for CY 2012 medication therapy management program submissions and related change requests. CMS also has issued a memo on CY 2012 formulary submissions, including timelines. 
Source: healthindustrywashingtonwatch.com

Medicare Supplemental Insurance, Medicare Supplements, Medigap

So what does this mean for beneficiaries that are new to Medicare A and B who are getting a Medicare Supplement/Medigap Plan for the first time?  You really should find a Medicare Supplemental Advisor that will do this work for you.  Why? Because it can be a frustrating and time consuming venture at the Medicare web site.  Just ask the wives of beneficiaries that have to listen to their husbands complain about the Medicare or other third party Part D web site.  This is very similar to “tax time rage.”  What I am referring to is the frustration that comes with “Medicare Part D Rage.”  And, even when you figured out how to get this valuable information one year, web sites change enough so that when next year comes around you can’t find it so easily again.  So, if you are new to Medicare A and B, or, or if you already have a Medigap plan, then find a reputable advisor that will go through this information for you.  As part of Medicare Supplemental Advisors’ Medigap plan enrollments, we provide this type of Medicare Insurance Report to our new and current clients each year.
Source: medicaresupplementaladvisors.com

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August 13, 2013

How to Protect Yourself from Medicare Fraud

Posted by:  :  Category: Medicare

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In rare cases, Social Security representatives may call Medicare beneficiaries if they need more information to process applications for Extra Help with Medicare prescription drug costs. If a phone call is needed, you will receive an official letter to arrange a phone interview, and you should be asked to confirm the date of your telephone interview by returning an acknowledgement form to Social Security.
Source: ehealthmedicare.com

Video: How to get data for Medicare Supplement Marketing

Telephone Scam Aimed at Medicare Beneficiaries

A caller says they are from Medicare and asks you to verify that you received a new Medicare member ID card. They also ask for your Social Security number, bank account number or address. The caller may say they are verifying your account information and need to send you important information about your Medicare ID card. The caller may also be unwilling to give you their name and call back number.
Source: insurancestores.com

Phone scam targets local Medicare users

AARP ACA affordable care act AMA AWV’s CMS coding CPT codes EHR exercise florida health care costs health care coverage health care data center health care law health care laws health care reform healthcare reform law health insurance HHS HIMSS HIPAA icd-9 icd-10 ICD codes insurance medcity medicaid medicaid services medicare medicare advantage medicare fraud obamacare orlando part b part d plan f preventive care recipes scams technology wellness wellness programs welltrackmd world health news
Source: tacticalminc.com

AMC Health helps Humana manage CHF in Medicare population

The pilot is for 450 individual patients who will be enrolled in the program for 9 months. The program and results published by Geisinger were for their 30-day Post-Discharge Transition of Care program using IVR (Interactive Voice Response) to supplement Geisinger existing Care Management model. Humana’s program is different in that it involves the transmission of real time weight and blood pressure measurements from patients in their homes which is then reviewed and acted upon by AMC Health nurses.
Source: mobihealthnews.com

Better Business Bureau warns elderly to beware Medicare/Medicaid scams

These people are asking for personal information such as Medicare, Medicaid, Social Security, credit card or bank account numbers in order to provide free services such as medic alert alarms, back braces, and other products that assist the elderly and infirm and are paid for by Medicare and Medicaid.
Source: bbb.org

Medicare Phone Presentations

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:   What is 17 minus one? I agree to forum rules 
Source: insurance-forums.net

Solving the Problems of Medicare through Entrepreneurship

Free the Provider. Doctors participating in Medicare today must practice medicine within an outmoded, wasteful payment system. Typically, they receive no financial reward for talking to patients by telephone, communicating by e-mail, teaching patients how to manage their own care, or helping them be better consumers in the market for drugs. These activities are not reimbursable, however, because Medicare pays only for specific tasks that must be performed in a doctor’s office or other provider setting, such as a hospital or laboratory. Thus, doctors who help patients in these ways are taking away from other billable uses of their time and, in fact, may end up with less payment from Medicare. Other health care providers face the same perverse incentives. All too often, high-cost, low-quality care is reimbursed at a higher rate than the alternative, and Medicare’s payment rules get in the way of providers working together to improve health care.
Source: cosbyig.com

Medicare’s Most Maddening Policy… and Why CMS’s Attempts to Improve It May Make it Worse

The potion that turned this particular policy into a monster was the Recovery Audit Contractor (“RAC”) audits, whose existence was authorized by the 2003 Medicare Prescription Drug Act. RAC auditors can target a hospital, pull a hundred or so charts, and, if they find improper billing, collect a bounty for every dollar they save CMS. With the determination of obs status so amorphous, hospital administrators have adopted a “better safe than sorry” stance, generally deciding that cases that are anywhere near a close call should be called obs. (Just this week, Beth Israel Deaconess Medical Center in Boston forked over $5.3 million to Medicare to settle charges related to admissions that auditors believed were really obs.) The result of all this angsty wheel-spinning: the number of obs cases in the U.S. went up by 50 percent between 2006 and 2011, with a more-than-400 percent (!) increase in Medicare patients staying more than 48 hours under observation.
Source: the-hospitalist.org

Phone Scams Target Medicare Beneficiaries in California

Callers claiming to be with the Medicare program tell their targets that a replacement Medicare card is coming in the mail but a bank account number is needed first, according to a press release from Ramsey’s office. Sometimes, the caller will ask for a Medicare card number, which can be used for identity theft since it’s tied to a Social Security number.
Source: medbill.net

Medicare Card Phone Scam Targets Senior Citizens

Callers have been asking victims to verify basic information such as a telephone number or mailing address, deluding them into providing much more private information such as a Social Security number or routing number.  This leads to subsequent unauthorized deductions from the checking account. This all comes with scammers utilizing the new changes from the Affordable Care Act as well to further confuse victims. If you have a senior whom you can warn, it is best to contact and make them aware sooner rather than later of this trending scam.
Source: pmbcgroup.com

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