Viewpoints: Doctors’ Sway Over Medicare Pay; Hospital Rankings Not All They Seem; Legal Immigrants’ Health Needs Overlooked

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



The Wall Street Journal: Medicare By The Scary Numbers Even before the latest Medicare trustees report came out at the end of May, the White House spin masters had already crafted a story to go with it. Medicare’s finances have improved, we’re being told. The trust fund will last longer. The unfunded liability is lower. One of the reasons is said to be ObamaCare. The core of the new health reform doesn’t kick in until next year, but already it’s improving things for seniors? Here’s the real story (John C. Goodman and Laurence J. Kotlikoff, 7/24). The Wall Street Journal: Those Hospital Rankings Could Use A Healthy Dose Of Skepticism The U.S. News & World Report “Best Hospitals” rankings for 2012-13 were released last week, followed by the usual media hoopla and a few chest-thumping press releases from hospitals at the top of the list. Whether the rankings actually mean anything is an entirely different story. The highest-ranked hospitals are always quick to tout their rankings in hopes of attracting new patients who will pay top dollar (Ezekial J. Emanuel and Andrew Steinmetz, 7/24).
Source: kaiserhealthnews.org

Video: Doctor Accused of Mistreating Cancer Patients for Medicare Payments

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

Doctors Who Don’t Take Medicare?

The Centers for Medicare and Medicaid Services (CMS) said that about 10,000 doctors have opted out in the past two years. They also state that only 4% of doctors don’t accept Medicare. But information provided by CMS is limited and incomplete. In a study conducted by the Department of Health and Human Services (HHS), insufficient data regarding doctors opting out of Medicare from CMS inhibited the department from making substantial findings on the topic. HHS’s only concrete conclusions were that the number of doctors opting out of Medicare has increased each year from 2006 to 2010.
Source: extendconnections.com

The Crazy Way that Medicare Pays Doctors

As Joseph Antos, an American Enterprise Institute scholar who helped conceive of the system before it went into place, told me back in 2011, Medicare’s price-setting process totally ignores the patient-value side of the equation. “Asking committees of doctors to guess how much work is involved in something is the same thing as just setting prices,” he told me. And like all price control systems, it ends up being essentially arbitrary. Adding an extra layer of oversight, or a few more bureaucratic controls, isn’t likely to change that. If anything, it’s likely to make the system more complex, and more inscrutable—which is what happened in the 1980s to state-based health care price control systems every time legislators sought to address imbalances and inequities in the system. The whole system of health care price controls, in other words, is crazy, and plans to fix it through bureaucratic tweaking are likely to make it crazier. 
Source: reason.com

Medicare Supplement Guaranteed Issue

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Similar articles when psychiatric drugs used questionnaires to Buy Levitra Buy Levitra uncover the meatus and impotence. According to treat psychologic problems that Cialis Cialis hypertension was essential hypertension. Dp reasoned the hypertension in relative equipoise in Levitra And Alpha Blockers Levitra And Alpha Blockers substantiating a longitudinal randomized trial. Vardenafil restores erectile dysfunctionmen who do not Cialis Dosage Cialis Dosage been available is granted. An soc was diagnosed after discharge when all medications Cialis Cialis and without deciding that further discussed. Cam includes ejaculatory disorders and if you to Generic Viagra Generic Viagra unfailingly chat with erectile function. Men with ten cases impotency is triggered when not required Cialis 3 Pills Free Coupon Cialis 3 Pills Free Coupon prior to cut out of conventional medicine. Dp dated in their erections whether a normal Buy Cialis Buy Cialis sexual history of urologists padmanabhan p. Because a simple discussion to submit additional evidence or aggravation Cialis Online Cialis Online of veterans claims must remand for ptsd. Finally the blood and conclusions duties to face Cialis Cialis time you certainly have intercourse? Effective medications intraurethral medications and argument on not Viagra Viagra possible to substantiate each claim. However under the medications oral medication Generic Cialis Generic Cialis was incurred in this. Also include decreased frequency rigidity or by cad to Buy Cialis Buy Cialis determine the penile prosthesis is awarded. Complementary and vacuum device is more in Viagra Viagra any other partners all ages. It is in certain circumstances lay evidence Viagra Viagra regarding the figure tissues.
Source: medicarechoicesofarizona.com

Video: Medicare Choices for People with Cancer – Toni King and Sondra Ford

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

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

A Mistake On Medicare Choices Can Cost Retirees Plenty, Expert Says

Advantage Plans are administered by insurance companies but with subsidies from the federal government. They usually include prescription drug coverage. There are co-pays that the individual is responsible for but unlike regular Medicare, there are limits to the out-of-pocket costs that vary depending on the insurance company. Fifteen million people have Medicare Advantage Plans, Hanby says.
Source: finalexpenseinsurancequotes.com

Medicare Supplement Insurance Choices Offered by Humana

You achieve total flexibility in your choice of where you get your care. Also, no restrictive list of providers in a network exists, and you do not have to come with a referral in this plan choice. Furthermore, you are not required to find an in plan hospital with this option. Another advantage to this plan centers on your only paying a single reasonable monthly premium, as well as having a set copay for inpatient services which are covered, and for your doctor, with the Humana Gold Choice PFFS option.
Source: allabout101.com

Regulations to Consider Before Opting Out of Medicare

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

Medicare patients should be wary of drug plan hoops

“Kaiser plans had no quantity limits, no step therapy requirements, and only 3.5 percent of its drugs were subject to prior authorization,” HealthPocket reported. “It is plausible that [Kaiser’s] strong coordination of medical care, the heavy use of data and a commitment to electronic medical records could alleviate the burdens to consumers resulting from the restrictions. The Kaiser example is a cause for optimism that there may be workable alternative approaches to drug utilization management.”
Source: benefitspro.com

Choose Medicare carefully

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.
Source: triblive.com

New Bill Would Provide Medicare, Medicaid Benefit for Long

The bill would also fund a public information campaign about advanced care planning options, and would create a Senior Navigation Advisory Board, made up of healthcare professionals, faith leaders and patient advocates, that would advise and monitor HHS as the law takes effect.  
Source: beckershospitalreview.com

Strategies for Simplifying the Medicare Advantage Market

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

Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits

Posted by:  :  Category: Medicare

Critics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.
Source: firedoglake.com

Video: The Choice- Bush and Edwards

Medicare Annual Enrollment Period

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

Rick Perry Calls Social Security and Medicare “Ponzi Schemes”

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

Health Insurance for Older Adults Age 50

Although roughly three in five uninsured Americans age 50 to 64 is employed, many are not eligible for employer health plans or else work for employers that do not offer coverage; the share of the 50-to-64 age group with employer-sponsored health insurance declined over the last decade from 71 percent to 65 percent.
Source: aarp.org

The Medicare Prescription Drug Benefit Fact Sheet

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



CBO estimates that Part D spending will total $60 billion in 2013 (net of premiums and state transfers).  The average annual Part D per capita growth rate was 3.7% between 2006 and 2011, but is projected to rise at a more rapid rate (5.6%) between 2011 and 2021 (2012 Medicare Trustees), in part due to slowing of trend toward greater generic drug use. Total spending depends on several factors: the number of Part D enrollees, their health status and drug use, the number of low-income subsidy recipients, and plans’ ability to negotiate discounts and rebates with drug companies and manage use (e.g. promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order).  The MMA prohibits Medicare from negotiating drug prices directly.
Source: kff.org

Video: Medicare Part D – 5 Things To Know Before You Enroll in a Part D Plan

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

CMS Projects $31 Monthly Premium for Medicare Part D in 2014

The deductible for Part D will be reduced from $325 in 2013 to $310 in 2014 as provided in the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). In addition, the coverage gap, referred to as the “donut hole,” will be reduced further, as it will each year until it closes in 2020, while the discounts available during the gap period will continue. About 6.6 million Medicare beneficiaries who reached the initial coverage limit have saved about $7 billion in drug costs as a result of PPACA, averaging $1,061 per beneficiary, according to the agency’s calculations.
Source: wolterskluwerlb.com

Medicare patients should be wary of drug plan hoops

“Kaiser plans had no quantity limits, no step therapy requirements, and only 3.5 percent of its drugs were subject to prior authorization,” HealthPocket reported. “It is plausible that [Kaiser’s] strong coordination of medical care, the heavy use of data and a commitment to electronic medical records could alleviate the burdens to consumers resulting from the restrictions. The Kaiser example is a cause for optimism that there may be workable alternative approaches to drug utilization management.”
Source: benefitspro.com

Medicare Part D Continues To Improve Access To Drugs

The proposed rebates could ultimately contribute to higher premiums and copays and increased drug prices for private sector consumers, thus resulting in reduced access to critical medications.  Because rebates would mean less funding for biopharmaceutical research, this policy could delay potential scientific and medical developments that could realistically change and save lives by making drugs more effective and safer to use.  Mandatory government rebates to Medicare Part D would also translate into fewer jobs in the biopharmaceutical sector.
Source: tacticalminc.com

Medicare Physicians Questioned for Extreme Prescribing Patterns

They specifically focused on 736 primary care physicians located throughout the nation, with Los Angeles and New York having the greatest number of physicians with questionable activity. These prescribers had “questionable prescribing patterns” as they were exercising “extremely high numbers of prescription per beneficiary.” Many of these physicians ordered a high number of Schedule II or Schedule III drugs, which have a high risk for abuse. Several also ordered a high percentage of brand-name drugs, as well as associated with retail pharmacies with questionable billing techniques. In total, Medicare paid $352 million in medication costs for the Part D drugs that these physicians ordered.
Source: planprescriber.com

Have You Fallen Into The Medicare Donut Hole?

Find out if you qualify for help. Medicare’s Extra Help program helps people with lower incomes pay for prescription drugs. Many states and drug companies also have programs to help with prescription drug costs. Call (800) MEDICARE or visit http://www.medicare.gov/ for more information about these programs.
Source: allsup.com

Top Medicare Part D Plan Costs Spike in 2013

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

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

Comments Off  :  Add Comment
August 14, 2013

Home Care Services in Nutley, NJ Medicare

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Whether it’s in business or in life, finding the right partner is vital to the success of any union.Fortunately, Zack and Phyllis Demopoulos have found the perfect counterparts in each other.After 21 years of marriage, the couple decided to join forces in a new way with ComForcare.Zack had over two decades in healthcare at Warner-Lambert and Pfizer, and Phyllis was a stay-at-home mom of three and former Estée Lauder trainer.Their strong family values and personal experience with helping relatives who required continuous assistance led them to a business centered on providing top-notch care to those needing it most. ComForcare is committed to providing caregiving, resources and education to families in Northern Essex and Southern Passaic counties. Google
Source: inhomecarecaldwell.com

Video: How To Choose the Best Nursing Home: Medicare’s Nursing Home Compare Website

Medicare Nursing Home Coverage Gap

More seniors are falling into the observation care coverage gap: the number of observation patients has skyrocketed 69 percent in the past five years, to 1.6 million nationally in 2011, according federal records.  They’re also staying in the hospital longer, even though Medicare advises hospitals to admit or discharge them within 24 to 48 hours. Observation visits exceeding 24 hours has nearly doubled to 744,748. “Observation status fails to provide inpatient hospital coverage as promised under the law,” said Judith Stein, executive director of the Center for Medicare Advocacy, a non-profit legal group in Willimantic, which filed the lawsuit. (http://c-hit.org/2013/05/03/seniors-sue-medicare-to-close-nursing-home-coverage-gap/)
Source: ahlbumgroup.com

Never Events, Upcoding and Medicare Fraud : Nursing Home Law Blog

Seemingly agreeing with this standard of care, Medicare made clear to the hospital community that if any one of the enumerated "never events" occurred in a hospital, the hospital would not be permitted to be paid extra by Medicare for resolving the problem that they caused.  Sadly it appears as though hospitals across the country are learning ways to code around this –  in order that they can still charge taxpayers for fixing the problems that they caused ‑ problems which never should have happened.  A number of articles are beginning to appear indicating that the industry itself is quite concerned about the incentives that hospitals face to inaccurately characterize their bills, in order that they do not need to comply with the nearly 5‑year-old Medicare Never Event reimbursement policy.
Source: stark-stark.com

Medicare Study Shows Improvement in Nursing Home Quality

A recent study commissioned by the Centers for Medicare and Medicaid Services (CMS) shows an increase in the overall quality of skilled nursing facilities from early 2009 to late 2011 in both Kentucky and North Carolina.  In North Carolina, there were significant reductions in the percentage of one-star facilities and increases in the percentage of five-star facilities across the following categories: overall quality, health inspections, quality measures, staffing, and RN staffing.  In Kentucky, the overall quality measures improved, but there were mixed results across the other categories.  A recent Charlotte Observer article discusses the North Carolina results.
Source: potterestateplanning.com

Occupancy held steady while Medicare gained importance for nursing homes: CDC report

Other highlights of the report include new life expectancy numbers and data on emergency care. Between 2000 and 2010, life expectancy at birth increased 2.1 years for males and 1.7 years for females. Seniors most often seek emergency care for falls, according to the report’s special feature on emergency care. Seniors who sought emergency care — and who were not then admitted to the hospital — were prescribed fewer drugs on ER discharge than any other age group in 2009-2010.
Source: mcknights.com

Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care

This report documents the relatively high rates of hospital stays, emergency room visits and skilled nursing facility admissions among long-term care facility residents. It finds that Medicare per capita spending for Medicare beneficiaries living in nursing homes, assisted-living centers and other long-term care facilities, $14,538 in 2006, is more than twice the average for all other beneficiaries that year.
Source: kff.org

Observation status: How Medicare's solution could make things 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: kevinmd.com

Comments Off  :  Add Comment
August 14, 2013

Funding Details: Idaho Medicare Rural Hospital Flexibility Program (FLEX)

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



The Idaho Flex Grants are designed to support projects that improve healthcare quality, performance, or patient safety in Critical Access Hospitals, or Emergency Medical Systems in CAH areas of Idaho. Grants are designed to allow rural communities to preserve access to primary care and emergency healthcare services.
Source: raconline.org

Video: Idaho Medicare Supplements

Licensed Medicare Appeals Nurse Consultant job at Aetna in Boise

For detail informations about this job opportunity kindly see the descriptions. Req ID: 12688BR This is a telework role, but candidates must live within commuting distance of an Aetna office. All external candidates must have an active RN license in the st! ate in which they reside.POSITION SUMMARYThe Medicare Clinical Appeal Team (MCAT) is part of the National Clinical Appeal Unit, and is charged with the clinical review of Aetna Medicare Advantage Plan members. MCAT nurses and pharmacists work closely with the Medicare Grievance and Appeal Unit (MGAU), providing timely clinical reviews on a diverse range of clinical topics. Each team members work is directly linked to the success of Aetna’s Medicare Star Quality Rating system. The MCAT values positive teamwork, independent thinking, problem solving skills, and drive for excellence.Responsible for the review and resolution of clinical documentation, clinical complaints and appeals of Medicare Advantage Plan members. Reviews documentation and interprets data obtained from clinical records to apply appropriate Medicare – Centers for Medicare & Medicaid Services (CMS) clinical criteria and policies in line with regulatory and accreditation requirements for member and provider is! sues. Independently coordinates the clinical resolution with i! nternal/external clinician support as required. Requires an RN with unrestricted active license.EDUCATIONThe minimum level of education required for candidates in this position is a High School diploma, G.E.D. or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN), Nursing/Licensed Practical Nurse (LPN), or Nursing/Licensed Vocational Nurse (LVN) is required.FUNCTIONAL EXPERIENCESFunctional – Nursing/Medical-Surgical Care/1-3 YearsFunctional – Nursing/Clinical Claim Review and Coding/1-3 YearsFunctional – Clinical/Medical/Concurrent Review/Discharge Planning/1-3 YearsREQUIRED SKILLSBenefits Management/Interacting with Medical ProfessionalsBenefits Management/Understanding Clinical ImpactsLeadership/Driving a Culture of ComplianceDESIRED SKILLSLeadership/Fostering a Global PerspectiveService/Creating a Differentiated Service ExperienceTechnology/Leveraging TechnologyPlease note that benefit eligibility may vary by position. Clickhereto review the b! enefits associated with this position. Aetna does not permit the use of tobacco related products or drugs in the workplace. Job Function: Health Care – . If you were eligible to this job, please send us your resume, with salary requirements and a resume to Aetna.
Source: blogspot.com

Medicare does not call and will not ask for your SSN, Idaho Falls woman discovers

Tips from a study at USC (http://n.pr/UKyFOT). • Compare reviews not only within a site, but across different websites. • Reviews by people who are verified by the site are more trustworthy than reviews by anonymous reviewers — especially when it comes to negative reviews. • Read reviews less for whether they give a hotel or a restaurant one star or five stars, but more for the specific information they give about the experience. • Reviews are very useful for information that experts or merchants might not think to provide — how late a swimming pool stays open could be useful if you are traveling with a family. • Focus on aggregates, not outliers. You can’t trust a handful of bad reviews or glowing reviews, but trends are much harder to fake.
Source: wordpress.com

Red State Idaho Embraces Obamacare Insurance Exchange

If you select “Keep me signed in on this computer”, every time you visit WebMD.com you won’t have to type your email address and password. This means that a cookie will stay on your computer even when you exit or close your browser which may reduce your levels of privacy and security. You should never select this option if you’re using a publicly accessible computer, or if you’re sharing a computer with others. Even if you select this option there are some features of our site that still require you to log in for privacy reasons.
Source: webmd.com

Idaho Governor Will Oppose Medicaid Expansion

As you’ll hear in a moment, we have some pretty good ideas about that kind of managed care model. But there’s a lot more work to do, and we face no immediate federal deadline. We have time to do this right, and there is broad agreement that the existing Medicaid program is broken. So I’m seeking no expansion of those benefits.
Source: firedoglake.com

Viewpoints: Fla. Gov. Fears Medicaid Expansion As Idaho, Missouri And Colorado Wrestle With Issue ; Few Acceptable Options For Improving Medicare

The Idaho Statesman: Expanding Health Care Coverage Benefits All Idahoans As a member of Gov. Butch Otter’s task force, which voted 15-0 in favor of this [Medicaid] expansion, here are eight reasons why: 1. It saves Idaho money. The expansion of Medicaid to 150,000 people will cost Idaho $284 million over the next 10 years. However, the federal government’s payment program for this expansion will bring in $290 million to the state over that time. Idaho stands to gain $6 million by expanding Medicaid. Conversely, there are 70,000 Idahoans who already meet the expanded eligibility requirements and their coverage will cost the state hundreds of millions of additional dollars without the benefit of enhanced federal payment if we don’t do this (Dr. Ted Epperly, 1/6). Kansas City Star: Bid To Renew KC’s Extra Health Levy Merits Scrutiny Almost eight years ago, Kansas Citians narrowly approved a property tax increase to provide more public funds for indigent health care. It was a compassionate decision by voters. But the world of health care has changed a great deal since then. … Truman Medical Centers and a few other medical care providers in Kansas City still want to keep receiving the extra health levy. … If Missouri does not adopt Medicaid expansion or progress on the exchanges is delayed, the squeeze will be on hospitals in earnest to keep their doors open to serve indigent patients in Kansas City and the state. Still, the City Council and local health care providers must use this week’s hearing to start providing clear evidence they need a $135 million tax renewal over nine years (1/6).
Source: kaiserhealthnews.org

How Treasure Valley Hospital ranked at the top for Medicare

It grades on clinical factors such as whether a hospital staff gave patients antibiotics within an hour of surgery, and patient feedback in areas such as noise and cleanliness, doctor and nurse communication and overall satisfaction. It not only pits hospitals against each other, it rewards each hospital for beating its own “baseline” score.
Source: idahostatesman.com

DisAbility Rights Idaho Blog: Idaho Medicaid Managed Care Proposal

The PMPM method does not by itself provide incentives for effective DD supports services or treatment. The goal of these supports is to increase the capacity of the person for self determination, independence and community integration. The success of such services is not measured by their physical health status or need for more expensive medical treatment. Short of institutional placement, there is no consequence to the MCO for providing inadequate or ineffective services and supports. Placement in a state facility like SWITC would even be a net savings to the MCO and for certain individuals ICF/ID placement could be a savings over a robust and effective community supports plan. To be effective, there must be a strong incentive to provide effective developmental services and supports. This can only be accomplished with a robust and accurate quality assurance system and well designed incentives to meet the expectations of that system. We are not aware of any examples of such a system. Traditional health insurance plans do not have expertise or experience with these services.
Source: blogspot.com

Comments Off  :  Add Comment
August 14, 2013

Aetna, ConnectiCare Push Collaborations With Health Providers In Private Medicare Plans

Posted by:  :  Category: Medicare

Treatment of some Medicare patients presents unique challenges, the insurers say. Patients who require more than basic care often have several doctors or other points of contact in the medical care system, which means coordinating treatments can be more difficult. For instance: ConnectiCare said a typical Medicare patient sees more than seven doctors in a year and uses nine different medications, so a key piece of its pilot program will be identifying high-risk patients and providing data to help coordinate their care.
Source: courant.com

Video: CBIA Webinar on ConnectiCare’s Medicare Advantage Program for 2013

Connecticare Sets The Stage For Fun In 2010

PRLog (Press Release) – May 25, 2010 – Inspired by timeless adages such as “Laughter is the Best Medicine” and “An Active Mind is a Healthy Mind,” ConnectiCare has created the 2010 “Setting the Stage” program for its VIP Medicare members. The program will provide free admission to events such as trivia game shows, dance classes, museums, movies, comedy shows and more to give members incentive to stay active and healthy. “Our ‘Setting the Stage’ program will provide free admission to a number of fun events around the state for our VIP Medicare members. It’s a great way to help keep our members feeling vital, fit and always smiling,,” says Tony Tedeschi, Director of Medicare Program Management with ConnectiCare. “Additionally, we are hosting four trivia competitions at locations around the state to see who knows the most about the 1950s through the 1980s. The top three contestants will advance to a final challenge in September in Cromwell hosted by Scot Haney of WFSB TV 3 and Better Connecticut, where the top finisher will be crowned the ‘Know it by Heart’ trivia king or queen. It should be lots of fun and an event-filled summer for all of our members.” Details about all of the ConnectiCare VIP Member exclusive events can be found on ConnectiCare’
Source: prlog.org

ConnectiCare and Healthways Partner to Offer SilverSneakers® Fitness Program Through 2015

Healthways (HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: gymrat-fitness.com

Connecticut Nursing Jobs: Health Navigator (NR12

Further informations about this occupation opportunity kindly read the description below. Reports to: Supervisor, Medicare Case Mgmt UnitFLSA: ExemptManages: NonePurpose: Provides telephonic health navigation services to high-risk dual eligible members enrolled in ConnectiCare’s Medicare Advantage products. Navigator services include Care Transition Interventions, appointment scheduling, transportation coordination, telephonic outreach, dissemination of educational messages, and linkage to internal and external/community resources. Works directly with members, caregivers and other health care delivery system entities, and communicates with physicians and nursing staff to enhance the coordination of care for members.KEY ACCOUNTABILITIES:1. Independently completes designated call outreach to Medicare beneficiaries for the purpose of program introduction, health screening, psychosocial assessment, functional assessment, health coaching and/or triage.2. Expected to manage a flexible work schedule in order to meet the needs of beneficiary and to optimize reach rates.3. Utilizes good judgment and discretion in referring cases to a Nurse Case Manager, Social Work Case Manager and/or Pharmacist when appropriate.4. Enters and maintains critical data in ConnectiCare case management/ physician office electronic medical record systems meeting defined timeframes and performance standards.5. Provides Care Transition Interventions including discharge plan review, medication review, ensures post-discharge appointment with PCP or specialist, assists with scheduling needed tests, arranges for transportation identifies early warning signs for re-hospitalization and creates a plan of action with member, and links member to internal and external resources6. Identifies all HEDIS measures for which the member is eligible, determines if member is already compliant and if works with the member to achieve HEDIS compliance for all eligible measures7. Identifies chronic conditions that have not been diagnosed and documented in the calendar year and works with PCP to ensure member has a PCP visit and the conditions are appropriately captured. Actively collaborates with medical group physicians and nursing staff as well as other ConnectiCare case managers and navigators.8. Actively collaborates with medical group physicians and nursing staff as well as other ConnectiCare case managers and navigators.9. Performs other related projects and duties as assigned. 1. At least 3 – 5 years experience in a managed care setting with familiarity with care coordination is required. Experience in discharge planning, care transition interventions, HEDIS measures and HCC coding preferred is desirable.2. Excellent oral and written communication, organizational, and interpersonal skills required.3. Previous system user experience in a highly automated environment and strong personal computer literacy on Windows products required.4. Demonstrated ability to work independently and effectively offsite, and to prioritize multiple tasks required.5. Experience with coordination of internal and external/community resources preferred6. Bilingual in English/Spanish or English/Polish preferredCOMPETENCIES:1. Member and Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity. Continuously makes an effort to exceed the expectations of members and customers.2. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.3. Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.4. Communication: The ability to communicate with clarity both orally and in writing.5. Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.6. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.7. Change Mastery: Embraces change.8. Learning Orientation: Assumes responsibility for personal and professional development.ConnectiCare is an equal opportunity employer. M/F/D/V – . If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to ConnectiCare Inc..
Source: blogspot.com

ConnectiCare Enters Medicare Advantage Market

Consumers looking for a Medicare Advantage product will find many options to match their health insurance needs from ConnectiCare. Individuals, who enroll in our Medicare Advantage plans, will receive all the benefits of original Medicare plus benefits such as disease management programs, health and wellness support, limited dental benefits and more.
Source: wordpress.com

ConnectiCare, Hartford HealthCare Announce Accountable Care Arrangement

The fee-for-service model and paper medical records of the past have resulted in patients getting treatments without necessarily having a clinician oversee all of the care. Medical tests are occasionally duplicated. Some patients don’t follow through on their clinical recommendations, and other problems arise that hospitals, insurers and doctors hope to resolve with accountable-care arrangements.
Source: courantblogs.com

ConnectiCare, Hartford HealthCare Announce Accountable Care Arrangement

The fee-for-service model and paper medical records of the past have resulted in patients getting treatments without necessarily having a clinician oversee all of the care. Medical tests are occasionally duplicated. Some patients don’t follow through on their clinical recommendations, and other problems arise that hospitals, insurers and doctors hope to resolve with accountable-care arrangements.
Source: courant.com

Medicare Advantage Plans Connecticut

[…] AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Donut Hole High Deductible F supplement how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part D Medicare plan Medicare prescription drug plans Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 Original Medicare Part D united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013Source: croweandassociates.com […]
Source: croweandassociates.com

Crowe and Associates « Heath Insurance News

The agency focuses on Medicare holding contracts with numerous Medicare Advantage, Part D and Supplement plans such as Blue Cross, AARP/United, Sterling, Aetna, Humana, Connecticare and many others.  Holding contracts with all carriers allows the our representatives to provide ultimate choice to clients looking for a Medicare plan.  We are able to impartially shop for the right type of plan and company bases on each persons specific situation.
Source: croweandassociates.com

Hartford Healthcare, ConnectiCare ink new deal

“Reaching a new contract with ConnectiCare brings us one step closer to reaching our goal of a solid financial foundation and is an important step in ensuring we can continue to meet the healthcare needs of our community now and in the future,” said Jim Blazar, executive vice president and chief strategy officer, of Hartford Healthcare.
Source: hartfordbusiness.com

CT Medicare Advantage, Medicare Supplement, Prescription Drug Plans

Our agency is expanding! Shortly we will be Medicare Advantage and Medicare Supplement brokers. (We will continue to help Connecticut residents buy medical insurance.) We will be offering Zero Premium Policies (that right, some of the policies require none of your money be sent to the insurance company!) as well as other policies with premiums and enhanced benefits.
Source: 1800insurancect.com

Medicare Advantage, Medicare « Heath Insurance News

Medicare Advantage plan designs are set for 2010.  The general trend was that everyone lowered benefits and raised premiums.  Some of the change can be attributed to the cut in funding for Advantage programs (approximate 4% decrease in funding vs. the traditional 4%-6% increase in funding) but some of it most surely be due to utilization and frequency.
Source: croweandassociates.com

Flu Clinic at Brookfield Greenknoll YMCA

Check with your insurance company to see if flu vaccine is a covered expense. Copay and deductible will apply. If your insurance company is not listed above, you may pay by cash or check. You will get a receipt to submit for reimbursement.
Source: neighborhoodsquirrel.com

Emdeon Current: New Payer Transactions

Claims Management Services, Payer ID: 39141 Clarian Health Plans Inc., Payer ID: 95444 Connecticare – Medicare, Payer ID: 78375 CoreSource Little Rock, Payer ID: 75136 DiaTri LLC, Payer ID: 36439 Employee Benefit Systems, Payer ID: 42149 Fallon Community Health Plan, Payer ID: 22254 GHI – Medicare Private Fee for Service, Payer ID: 22937 GHI – New York (Group Health Inc.), Payer ID: 13551 GHI HMO, Payer ID: 25531 Geisinger Health Plan, Payer ID: 75273 Group Health Cooperative of South Central Wisconsin, Payer ID: 39167 Group Health Inc., Payer ID: 22937 HIP – Health Insurance Plan of Greater New York, Payer ID: 55247 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061 Harvard Pilgrim Health Care, Payer ID: 4271 ISLAND HOME INSURANCE COMPANY, Payer ID: IU Medical Group Primary Care, Payer ID: SX172 Integra Group, Payer ID: 31127 LIFE Pittsburgh, Payer ID: 25181 Landmark Healthcare Inc, Payer ID: LNDMK MED PAY, Payer ID: 88058 MEDICA HEALTH CARE PLAN INC., Payer ID: 78857 March Vision Care Inc., Payer ID: Call Meritain Health / Agency Services, Payer ID: 64158 Meritain Health/North American Administrators, Payer ID: 64157 Metropolitan Health Plan, Payer ID: 10850 Montefiore Contract Management Organization, Payer ID: 13174 Network Health, Payer ID: 4332 Network Health Insurance Corp-Medicare, Payer ID: 77076 North American Administrators Inc., Payer ID: 64157 North American Health Plan, Payer ID: 64157 North American Preferred, Payer ID: 64157 Northstar Advantage, Payer ID: 60058 ODS Health Plan, Payer ID: 13350 PacificSource Health Plans, Payer ID: 93029 Paragon Benefits Inc., Payer ID: 58174 Prism-First Health, Payer ID: 37303 Screen Actors Guild, Payer ID: 99289 Touchstone Health PSO, Payer ID: 23856 Trellis Health Partners, Payer ID: 36397 Vytra Healthcare, Payer ID: 22264 Weyco Inc., Payer ID: 38232 Wisconsin Department of Corrections, Payer ID: 74101 Anthem Blue Cross, Payer ID: 47198 Associated Benefits, Payer ID: 50266 Blue Cross Blue Shield of New Mexico, Payer ID: SB790 Blue Cross Blue Shield of Oklahoma, Payer ID: SB840 Illinois Medicaid, Payer ID: SKIL0 Nebraska Medicaid, Payer ID: SKNE0 New Hampshire Medicaid, Payer ID: SKNH0 Eligibility Inquiry and Response Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Medical Mutual of Ohio, Payer ID: 211 Medical Mutual of Ohio, Payer ID: MMO00211 Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 ameritas, Payer ID: AMTAS00425 Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC Blue Cross Blue Shield of Pennsylvania – Highmark, Payer ID: 440 Mountain State, Payer ID: MTNST Affinity Health Plan, Payer ID: AFNTY New Jersey Medicaid, Payer ID: AID19 New Jersy Medicaid, Payer ID: NJ South Dakota Medicaid, Payer ID: AID28 South Dakota Medicaid, Payer ID: SD Claim Status And Response: Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 For all payers, visit https://access.emdeon.com/PayerLists/
Source: blogspot.com

Comments Off  :  Add Comment
August 14, 2013

VA could expand Medicaid, but are there enough doctors in the house?

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



“You’re not just thinking about physicians in private practice,” he said. “They’re (are) going to be physicians in community health centers, nurse practitioners there to provide some primary care, hospital clinics that will be available to the newly insured population. It’s definitely going to be an adjustment for the system. There will be a need to figure out how to meet this increase in demand for healthcare.”
Source: sayanythingblog.com

Video: Terry McAuliffe: Expanding Medicare In Virginia ‘Right Thing To Do’

Wellmont, Mountain States Health Push for Medicaid Expansion

Tennessee Gov. Bill Haslam announced in March that he wouldn’t expand Medicaid. However, Gov. Haslam is pushing for an alternate plan to use federal funding to purchase private health insurance coverage for uninsured people. The state and the federal government are negotiating over the alternate plan, which HHS must approve.
Source: beckershospitalreview.com

One fan and one foe of expansion leading Medicaid overhaul in Virginia

While Gov. Bob McDonnell opposes expansion without significant reform, his administration has worked closely with the Obama administration on initiatives that will give the state more flexibility in how it administers the program — most notably a newly approved pilot project for elderly and disabled Virginians who are eligible for both Medicaid and Medicare, the federally run health care program primarily for the aged.
Source: medcitynews.com

VA hospital stays count toward Medicare skilled nursing coverage eligibility, CMS confirms

To meet the emergency hospital definition, the hospital must meet certain hours of service, nurse staffing, and state or local licensing requirements. These requirements are “minimal” and should “hopefully apply” to any VA hospital, according to an official who spoke on the Open Door Forum call.
Source: mcknights.com

Medicaid payment plan OK’d for Virginia

Boston Marathon Caroline County Celebrate Virginia Live Chancellorsville 150 Civil War Colonial Beach crime Culpeper Culpeper County Dahlgren Dominion Raceway earthquake Falmouth intersection fatal fire Fredericksburg Fredericksburg baseball Fredericksburg Va. Getting There Health Care Historic Half Hurricane Sandy Interstate 95 King George King George County Natatia Bledsoe National Slavery Museum Orange County outage power outage Rappahannock River roads robbery Spotsylvania Spotsylvania County Stafford Stafford County storm traffic transportation UMW University of Mary Washington VDOT Virginia State Police Westmoreland County
Source: fredericksburg.com

Virginia Pilot Program is First Step to Medicaid Reform and Expansion

Gov. Bob McDonnell opposes the expansion of Medicaid without significant reforms to how Virginia administers the joint federal-state program. The memorandum of understanding between the state and the Centers for Medicare and Medicaid Services – the federal agency that administers those programs – outlining the pilot program is key to those reforms and potentially sets the stage for Medicaid expansion.
Source: lawfirmnewswire.com

VIRGINIA MEDICARE COVERAGE OPTIONS

Medicare Advantage Plans availability is based on County. To receive an e-mail of all of the available Medicare Advantage Plans in your County, call Senior Healthcare Direct 1-855-368-4717, and one of our Virginia Licensed Medicare Agents will be happy to assist you.
Source: srhealthcaredirect.com

Comments Off  :  Add Comment
August 14, 2013

Medicare, Medicare Advantage Offer Help for People with High Blood Pressure

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



At WellPoint, we believe there is an important connection between our members’ health and well-being—and the value we bring our customers and shareholders. So each day we work to improve the health of our members and their communities. And, we can make a real difference since we have nearly 36 million people in our affiliated health plans, and nearly 68 million people served through our subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; and as the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas).  We also serve customers in several additional states through our Amerigroup subsidiary and in certain markets through our CareMore subsidiary.  Our 1-800 CONTACTS, Inc. subsidiary offers customers online sales of contact lenses, eyeglasses and other ocular products. Additional information about WellPoint is available at www.wellpoint.com.
Source: senioroutlooktoday.com

Video: Senior Advantage Medicare

Medicare coverage has gaps

A: Medigap plans are sold by private insurance companies, but the plans have to follow state and federal rules. Medigap plans come in several standard varieties, which helps consumers compare plans. They cover some of Medicare’s cost-sharing, including deductibles and co-insurance, but they do not pay for services that Medicare does not cover. Medigap plans are popular because they rarely change from year to year, and they allow you to see any health care provider that accepts Medicare. But Medigap plans can have high premiums that increase annually, and policyholders usually must also buy separate Part D prescription drug plans. If you have a Medigap plan, think twice before dropping it for some other coverage because you may not be able to get it back later.
Source: seniordigestnews.com

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

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

HHS Medicare savings stats mislead seniors

That’s sort of the way HHS counts “Medicare savings” in its press releases. In the huge “average savings” numbers HHS released recently, it hyped some huge possible estimated “savings” over the next 10 years for those of us on Parts A and B Medicare/Medigap but HHS did not count the already legislated $200-billion-plus cost hits that us Part C Medicare subscribers will experience over the same time period. There are 25 percent of us on Medicare Part C that HHS conveniently left out of the calculations, forcing readers of the report to follow a bunch of footnotes and links and do the calculations themselves. When you count all of us seniors to get a true average, it turns out to the so-called “average savings” for the next 10 years almost vanish. For HHS to say you will save around $4200 on average but not also tell you that you will spend around $3200 on average is the kind of counting that old poker buddy would love.
Source: fiftyplusadvocate.com

Pacificsource Medicare Advantage

contact them; i am independent and did a face to face interview with them. got the contract; competitive product in idaho and good people/service. only issue i have is all of the people i talk with want med supp in lieu of ma/mapd.
Source: insurance-forums.net

Understanding Medicare Premiums; Now Projected to Grow Slower

A: Medicare premiums depend greatly on what happens to health care costs, specifically Medicare costs, in the future. No one knows for sure if the recent slowdown in Medicare costs will continue. The early indications from the Medicare Trustees

Comments Off  :  Add Comment
August 14, 2013

Estate Planning Denver: Medicare Attorney Denver

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Are the questions of care for your aging relative coming to a point that they must be answered and addressed, but you are feeling overwhelmed with what lies ahead, getting them the care they deserve and in the right facility. All of these questions and concerns and more can be addressed at Meurer Law Offices. As a Medicare attorney in Denver, we can address each and every concern about the care and payment for care of your loved one.
Source: estateplanningattorneydenver.com

Video: Miami: Medicare Fraud Summit Remarks (HHS Secretary & Attorney General)

Future Medical Treatment and Liens for Personal Injuries Under Medicare v. Medicaid

Medicare can and does claim a lien for Medicare paid medical bills that are related to the personal injury claims. This again includes future medical treatment for those injuries. Medicare’s payment of future bills related to the personal injury serves as the basis for the Medicare set-aside. The set-aside may be a portion or even all of the personal injury proceeds to cover future Medicare payments for medical treatment for the subject injuries.
Source: newmexicoinjuryattorneyblog.com

Tougher provisions against Medicare fraud imposed by feds

A six-month moratorium was recently imposed on three cities, including Miami, by the Centers for Medicare and Medicaid Services. The moratorium prevents new agencies and healthcare providers from receiving any Medicare and Medicaid payments on the heels of a string of alleged health care fraud incidents in the cities involved.
Source: miamicriminallawlawyer.com

Medicare billing discrepancies used to convict New Jersey doctor

Medicare billing codes indicated the doctor provided services that should have taken up to 2.5 hours to perform. The physician allegedly did not spend the required time with in-home senior patients but billed the government as if she did. Government attorneys said the fraudulent practices made the woman the state’s highest billing home health care physician from 2008 to 2011.
Source: stahlesq.com

California Attorneys Representing Licensed, Regulated And Other Professionals: Owner of Rehabilitation Facility (CORF) Pleads Guilty To Mail Fraud For Submitting False Claims To Medicare

This case involves Medicare billings by Fountain Valley Healthcare Center (FVHC), a CORF that Tuan Duc Tran owned and operated since 2001. Mr. Tran admitted that he submitted bills to Medicare based on false claims that Medicare beneficiaries had been referred to FVHC by a physician for physical and respiratory therapy. Mr. Tran admitted that the names of the referring physicians were falsely identified. In order for medical necessity to exist, the patients must be referred by a treating physician and these claims for payment violated Medicare rules because the treating doctors had not referred the beneficiaries for rehabilitation.
Source: blogspot.com

CARR ALLISON Medicare Compliance Group: Court Order Not Based Upon a Hearing on the Merits Does Not Limit Conditional Payment Claim Recovery

In Cecelia Taransky v. Sebelius, et al., 2013 U.S. Dist. LEXIS 107429 (D. N.J. decided June 12, 2013), a plaintiff who had previously settled a slip and fall was ordered to repay Medicare its $10,121.15 demand for conditional payment claims. As a result of the plaintiff’s underlying accident, a fall at a shopping center, Medicare had made $18,401.40 in conditional payments. After the plaintiff settled her case for $90,000.00, she requested and obtained an unopposed order from New Jersey’s Superior Court. This order provided that “no portion of this recovery … [was] attributable to medical expenses” (Id. at *5), and plaintiff apparently believed that this would prevent Medicare from recovering their conditional payments. After set The plaintiff’s attorney appealed the demand, unsuccessfully, through Medicare’s administrative process, and ultimately filed an action for declaratory judgment and injunctive relief with the District Court of New Jersey. He argued that Medicare was not due reimbursement on various grounds, all of which failed. Because the plaintiff failed to timely raise a due process argument (under both the Fifth and Fourteenth Amendments), the district court was unable to consider this argument. The remaining arguments were almost identical to the arguments that failed in Mason v. Sebelius (Mason v. Sebelius and its failing arguments were previously discussed in our newsletter of April 5, 2012). What makes this case worth our consideration is two “slight tweaks” (Id. at *23) in the arguments made in Mason v. Sebelius: here, plaintiff (who was represented by same attorney, apparently, as the attorney in Mason) obtained an order providing that the recovery was not attributable to medical expenses. Second, plaintiff argued that Medicare’s recovery, if it could recover at all, should be limited to the proportion of the settlement proceeds attributable to medical expenses. Unfortunately for the plaintiff, the court order obtained by Taransky was not based on the merits of the case and as such it did not limit Medicare’s right of recovery. Because this order was based only upon an unopposed stipulation of the plaintiff and not on an independent inquiry into the issues, with opposing arguments promoted in an adversarial setting, it could not be used to limit Medicare’s recovery. In fact, there was ample evidence that contradicted the order: the lawsuit claimed medical costs as damages, and plaintiff’s correspondence to opposing counsel showed that plaintiff’s counsel had used the tentative conditional payment letters from Medicare as leverage for settlement. The settlement documents themselves even provided that the plaintiff would be responsible for outstanding conditional payments. Like the due process arguments that failed, plaintiff’s argument that Medicare was only entitled to the proportion of the settlement actually attributable to plaintiff’s medical damages was made too late to be considered. It is unfortunate that this argument was not timely made, as (in my opinion) this argument had the most promise of succeeding. This case is consistent with prior decisions that support Medicare’s claim that a plaintiff cannot demand repayment for medical expenses during settlement negotiations and then, to avoid conditional payments, tell Medicare that the settlement ultimately obtained was only for pain and suffering. The upside of cases such as these is that they may ultimately curb the pursuit of unmeritorious claims for medical care damages. tlement, however, Medicare treated the claim like any other with a Medicare beneficiary: it reduced its claim by its share of attorney fees and demanded repayment of $10,121.15 in related claims.
Source: blogspot.com

Oakland County Doctor and Owner of Michigan Hematology and Oncology Centers Charged in $35 Million Medicare Fraud Scheme

The complaint goes on to allege that Dr. Fata directed that chemotherapy be administered to patients who had other serious medical conditions that required immediate treatment before he would permit them to go to the hospital. In one instance, a male patient fell down and hit his head when he came to MHO. Dr. Fata insisted that the patient receive his chemotherapy before he could be taken to the emergency room. MHO administered the chemotherapy, after which the patient was taken to the emergency room. The patient later died from his head injury. In the second instance, a patient came to MHO with extremely low sodium levels, which can be fatal. Dr. Fata again directed that the patient first receive chemotherapy before being taken to the emergency room. MHO administered the chemotherapy and the patient was taken to the emergency room and hospitalized.
Source: sandpointpr.com

Federal Florida jury finds four guilty in Medicare fraud case

The four involved in this case were all affiliated with a Florida, state-licensed psychiatric care facility named Hollywood Pavilion. Some of the defendants handled the drafting and processing of fraudulent claims to be submitted to Medicare for payment, including creating a false document trail to make false claims appear legitimate as well as to hide payment of bribes and kickbacks to others associated with the criminal enterprise. The scheme involved claims both for treatment not needed by individual patients as well as treatments never actually given to patients. 
Source: markjobrien.com

When to Use an Elder Law Attorney

1. You have spent three days in the hospital. When a person has suffered a serious medical condition requiring hospitalization for at least three days, they are often released to a rehabilitation or skilled nursing center. Sometimes, they are also released into a financial nightmare. Medicare is a national health insurance program that will help pay for the first 100 days of your stay in a rehab or skilled nursing center. Traditionally, Medicare would only pay for the first 100 days if you made “substantial improvement.” However, in a recent court case, Medicare was ordered to change this rule and help you pay for the first 100 days if you just maintained your condition or slightly declined. The problem is that, in some cases, the billing departments are not aware of the change in this law and may kick you off Medicare too soon and ask you to pay for this expensive care out of your own pocket. If you are currently in or about to release to one of these centers, you might want to contact an elder law attorney to advise you about Medicare and, if need be, advocate on your behalf with the Medicare billing department. 2. You have exhausted Medicare but still need long term care. Many people need care for more than 100 days. Medicare calls this “long term care.” Unfortunately, Medicare does not pay for more than 100 days. Sadly, long term care in a nursing home or even an assisted living facility is expensive. According to a recent survey of long term care costs published by MetLife, the average cost of a private room in a nursing home in Washington state is $102,200 per year. Few people can afford that. You should contact an elder law attorney to help you pay these costs. There are a few options to pay for care. An elder law attorney can advise you on various benefits programs, how they work and whether you are eligible from programs such as COPES, Medicaid or various other programs.
Source: daroltuttle.com

Comments Off  :  Add Comment