CMS finalizes Medicare rate updates, quality measure changes for hospices, inpatient rehabilitation facilities

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IRFs also must report on quality measures, and the final rule has three new measures: all-cause unplanned readmissions for 30 days post-discharge; percent of residents/patients assessed and appropriately vaccinated for the seasonal influenza (short-stay); percent of residents/patients with pressure ulcers that are new or worsened (short-stay).
Source: mcknights.com

Video: CMS Medicare Plan part A 2013, Medicare plan explained in under 10 minutes

Fewer Doctors Treating Medicare Patients, CMS Says

The Wall Street Journal: More Doctors Steer Clear Of Medicare Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts. The number of doctors who opted out of Medicare last year, while a small proportion of the nation’s health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system (Beck, 7/28).
Source: kaiserhealthnews.org

CMS Moves Toward Greater Transparency

In addition to releasing this request for public comment, CMS is also announcing four new qualified entities (QE). Created as part of the Affordable Care Act, the Medicare Data Sharing for Performance Measurement Program allows organizations to combine Medicare claims data from CMS with claims data from other payers to evaluate the performance of providers, services, and suppliers. The four additional QEs named today are Minnesota Community Measurement (MNCM), Wisconsin Health Information Organization (WHIO), Minnesota Department of Health (MDH), and the Center for Improving Value in Health Care (CIVHC). They will join the seven existing QEs in helping CMS improve quality, reduce costs, provide important information to beneficiaries to help them make health care decisions, and increase transparency.
Source: cms.gov

CMS Seeks Input on Disclosure of Individual Physicians’ Medicare Payments

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

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

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

CMS Releases FY 2014 Medicare Payment Regulations for Inpatient Psychiatric Facilities

CMS’s Rehabilitation, Psychiatric, and Long Term Care market basket index, which reflects changes in the prices of goods and services in IPFs, inpatient rehabilitation facilities and long term care hospitals, projected a 2.6 percent price increase.  However, the market basket increase was reduced by a 0.5 percent multifactor productivity adjustment and an additional 0.1 percent adjustment, both required by the Affordable Care Act.  In addition, the high cost outlier threshold for Fiscal Year 2014 resulted in a 0.03 percent increase.  Accordingly, the actual payment increase will be approximately 2.3 percent.  CMS estimates that it will spend an additional $115 million for inpatient psychiatric care because of the payment rate increase.
Source: jdsupra.com

CMS 1500 Medicare Claim Form Gets ICD

CMS also released a tentative outline for phasing in the new documentation. The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted. NUCC notes that the timeline may change, and urges providers to check with their payers and clearinghouses to determine when they will begin to accept the new 1500 form. NUCC has also provided an instruction manual for using the new 02/12 form, and asks providers to keep an eye out for any CMS updates to the process.
Source: advanceweb.com

Centers for Medicare and Medicaid Services (CMS) Issues Revised Process for Making National Coverage Determinations

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Source: nationallawforum.com

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

CMS noted that it expects its proposed enhancement to the IRP reward to encourage more people to come forward with information, leading to an increase in the recuperation of health care fraud funds. This expectation is based on the success of an Internal Revenue Service (IRS) program that pays individuals for reporting IRS tax code violations. The IRS reward program—which pays whistleblowers 15–30% of the amount collected by the IRS for all claims filed after July 1, 2010 and pays 15% of the amount collected for claims under $2 million filed before July 2010—has both paid out more rewards and collected more money than the IRP. Since its inception in 1998, the IRP has paid out only 18 rewards, totaling $16,000 in reward payments and less than $3.5 million in collected funds. The IRS program, on the other hand, paid out approximately $193 million in rewards and collected almost $1.6 billion from 2007–2012. CMS did not comment on whether it believes there is a comparable level of Medicare and tax code fraud.
Source: upenn.edu

U.S. Senators Welcome CMS Action To Prevent Medicare Waste Fraud & Abuse

“While it’s certainly better late than never, it’s unfortunate that CMS took three years to use the tools it’s had to protect seniors, who rely on Medicare, from fraud and abuse,” said Orrin Hatch, member of the senate finance committee with oversight over the Medicare program. “With CMS finally acting to crack down on fraud in high-risk areas in Miami and Houston, America’s seniors will be better protected from those wishing to gain the system putting their care in jeopardy, while helping sure up Medicare’s finances.” 
Source: fraudwhistleblowersblog.com

Cigna Medicare Plans: A Good Overview

Posted by:  :  Category: Medicare

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

Video: Medicare Advantage Plans from Cigna-HealthSpring [4 of 6]

Cigna Medicare Plans: That Overview

To prevent financial difficulties as a result expensive medical applications and high costs of medicines, could must that you should secure your health care costs in the. Have a medicare supplemental insurance insurance plan to be able to so that you’ll have not have a condition on your controlled bills. Along with a Medicare supplemental insurance policy you can make certain that you are easily taken cared to while sick with recuperating in a hospital bed. Medicare health insurance Component C: Medicare health insurance Component C (also named the Treatment Gain Program) associates to a cope more detailed protection coverage plans offered to seniors according to personal insurance establishments. Component C’s positive resources contain protection specified underneath Areas A great and B, seeing that very well as dental, vision not to mention other benefits. Aspect C commonly incorporates Portion Ve had coverage as properly. Some Component C types require the repayment of a distinct top quality additionally to the high quality needed in support of Component B offer. Medicare health insurance Supplemental Plan F covers the Part A deductible, who is 00 of 2010 and all the Part B every year deductible, which is 5 for ’10. In extension, the Medicare supplements Plan covers each of our 20% co-insurance just that genuine healthcare does not pay because of Part A and furthermore Part B. There are plus a few extensional profits including a trustworthy foreign trip reward and a “Part B excess Charges” benefit. This excellent inclusive plan markets the perfect policy cover money can purchase. Summary of looking at Supplemental Medicare Insurance Plans and Their Benefits Plan F also its fellow software programs as something for be afraid coming from all. Embrace these kind of people because they continue to keep you from financial ruin and allow you to get the medical maintenance that you might want. Take this few minutes and read about this guidance and how they work before a start shopping so that you may be more set up and informed on what is popping up your way. Most importantly, has not sell yourself tiny by rushing in the course of the process together with not getting what normally you need, while you will rule it someday. Once you are looking for best Medicare Insurance, you are able to should keep some important points in mind to go for very long term security. The plans written by the insurance vendors would not change, therefore you definitely should focus on cost Medicare insurance measures that you are looking at affordable premium. Some plans costly precious and extended to start with, but will possess a slow growth increasing over the life of your policy. Prominently, it is the best quality Medicare health like plan to go into all type involving health care overheads according to your trusty expectations completely. Any comes across all of the types of insurance, Medicare supplement insurance package attributes amongst some of these. It is forever better to be informed when it is about the Medicare supplement health insurance because there have proven to be stable changes regarding insurance policy; often change for better however at time intervals it is and not. It is significant to monitor that these varying trends whether or not you’re previously on Medigap insurance or aspire to register for the same. There is an important in order to a plan; and even since the techniques are being modified, the companies will most certainly be commencing to cost the new rates. This is the primary step behind change ever due to the 1992. Prone to are eligible adjust insurance companies towards Medicare Part D during the core year then existing plan will spread all of those total drug worth amounts and utter out of money amounts to brand new plan. If you decide to are in the top’s gap and a switch plans, you will still be the actual world coverage gap. Every Medicare Part D plan only at that point in time has a coverage gap so there is not a way of getting away from it if you are a lot related medications. There are some plans currently available that will coverage generic tier sole medications during the protection gap.
Source: typepad.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

Cigna Medicare Plans: A Major Overview

Original Medicare provides good insurance, but this one protection may far from come close of being enough . For this reason many Medicare beneficiaries have chosen to finally supplement their protection or to conclude a Medicare Portion C policy but of depending within Original Medicare. It is also in your best concentration to reevaluate our own Medicare supplemental plan you have picked out each and yearly. It is always important to read out the new-found policies and what exactly current plans were still available. If you do understand your needs usually are changing now is often the time to take care associated with these. When open up the enrollment comes along, review your well-being insurance plans and needs. This possibly can save you hard earned money from paying supplemental for benefits your family don’t need. To gain seniors that have no coverage by an Hmo or PPO regarding plan during specific initial enrollment period, it is recommended that they participate Medicare Part Cid and Part D. They cover medical insurance and confident prescriptions, respectively. Most people actually are automatically enrolled near Medicare Part A brand new when they turn eligible for Social Security. Ahead of enrolling for medicare supplemental insurance, the individual needs to know the current strength plan they have enrolled for. The health schematics that the traders will have are Medicare Part A meaningful or Part Y simply. Medicare supplemental plan Fahrenheit approved by the middle for Medicare Providers (CMS), which relates every company just need to provide the exact same real benefits when selling this plan to seniors. They can add extensional benefits, nor can they’ll clear away or modify any effects. Knowing Medicare Supplement Systems F is the sun’s rays similar unconcerned of which company is providing this option, in order to wise to shop for a plan from the actual company who might be giving the pricey price. Low Income Subsidy (LIS)/State Pharmaceutical Assistance Tv show (SPAP) Beneficiaries: People who qualify because of LIS or SPAP are eligible to enroll into a Medicare Part M plan at almost any time during an year. That they are also eligible to disenroll such as Medicare Part E plans at the moment during the calendar months. Could possibly need to exactly what a Medicare supplemental insurance plan actually that you will manage to benefit to it nicely. Then after you understood its purpose, the next option is learn things companies are honorable in the subject of Medicare improve insurance policy going.Medicare supplement policies are a tool that exist in order make sure that a better future for you you.
Source: typepad.com

Free Insurance Agent Websites: Cigna Medicare Advantage plans

CIGNA Medicare supplement plans have been an integral part of the insurance industry with having served customers for over 220 years. This kind of insurance plan can be very beneficial for all people including senior citizens who may be suffering from constant medical issues due to their advanced ages. The company enjoys a lot of goodwill among the community and here are some of the benefits that come with buying this plan.
Source: blogspot.com

Cigna Acquires Medicare Advantage Plans From Humana Covering 3,500 in Texas

The federal government required Humana to sell the Medicare Advantage plans as part of approval for buying Arcadian Management Services. Cigna will offer the new customers Medicare Advantage plans through its subsidiary HealthSpring, which the Bloomfield-based health insurer acquired in January for $3.8 billion.
Source: courant.com

NRC Capitol Clips: New Federal Rule Addresses Medicaid Transportation

Posted by:  :  Category: Medicare

This rule concerning “benchmark” plans in Medicaid takes effect July 1, 2010. States’ requirement to assure non-emergency medical transportation is nothing new; that has been in place for many years, first as a result of federal court cases, and then as a matter of CMS regulation. Now that medical transportation providers may be feeling some level of justified comfort that their services are not going to be ended (that was a very real fear in response to CMS’ initial proposals on this rule), there are some points of this latest rulemaking that bear careful consideration. 1. “Benchmark” plans are an option that is available to states. There is no requirement that states adopt this optional approach to elements of their Medicaid programs. However, CMS estimates that 90 percent of states will have some form of benchmark programs in place within a year or two. Given the nature and scope of the newest federal health legislation, that number is probably too low, and it’s much more likely that nearly every state will have some form of benchmark-like coverage in their Medicaid programs in the near future. Therefore, anyone who’s trying to set up systems for the future implementation of Medicaid should read more of today’s rule, and see how CMS is beginning to instruct states in their relations with insurance companies, managed care organizations, and other intermediaries. 2. The rule on benchmark plans has some reminders that CMS has an option by which states can provide Medicaid transportation through a brokered program (defined by regulation at 42 CFR Section 440.170(a)(4), in which case these transportation expenses can be covered as “medical services” (and thus reimbursed by CMS at the state’s Federal Medical Assistance Percentage rate, instead of the fixed 50 percent reimbursement for Medicaid program administrative costs) even if certain requirements for medical services (such as patient freedom of choice) are not part of the “brokerage.” As with the benchmark program, it is very important to remember that such Medicaid transportation brokerages are an option available to states; they are not required. 3. For the first time that I’ve ever noticed, the benchmark rule has a requirement for public participation in Medicaid planning. It’s a narrow window, and simply requires states to solicit public comment if they are preparing a state Medicaid plan amendment in pursuit of creating a benchmark program. Maybe there’s always been a requirement for public input; if so, it may be something to be more aggressively publicized. 4. In case people hadn’t been following this trend, in both the previous and current presidential administrations, CMS is having options and features of Medicaid being addressed by states through Medicaid plan amendments, and not through waiver requests. Although Medicaid planning is nothing at all like transportation planning, the fact that more process-driven approaches are being dictated by the federal government may give more opportunities for meaningful involvement by stakeholders as states pursue their Medicaid strategies. 5. And for those people who follow federal interagency coordination policies, there is this verbiage, as it appears in the CMS rulemaking notice: “We do not believe that Executive Order 13330, which relates to the coordination of transportation among Federal agencies, is relevant to this rule.”
Source: blogspot.com

Video: What Health Care Services Are Covered by Medicare?

Ask The Expert: Medical Transportation, Spirit Medical Transport …

A: Stipulations of insurance coverage vary from carrier to carrier. In many cases we will check on eligibility for a patient before their first transport to ensure they have proper coverage. In the cases of Medicare, to be covered, ambulance service must be medically necessary and reasonable. Medicare looks at two main factors when determining “medically necessary” and “reasonable.” Medical necessity is established when the patient’s condition is such that use of any other method of transportation is contraindicated. Additionally, Medicare will look at the reasonableness of the ambulance trip. An ambulance trip may not be covered on the grounds that the use of an ambulance was unreasonable in the treatment of the illness or injury involved notwithstanding the fact that the patient’s condition may have contraindicated the use of other means of transportation. Most Ohio Medicaid coverage plans cover ambulance or wheelchair van transportation to a physician’s office permitting the patient’s condition was medically necessary. For patients on Medicaid in Ohio, wheelchair van coverage is paid permitting the patient is “non-ambulatory.” Non-Ambulatory is defined as a patient who has a permanent or temporarily disabling condition which precludes transportation in a motor vehicle or motor carrier that has not been modified or created for transporting a patient with a disabling condition.
Source: seniorsguideonline.com

Medicare Coverage: Does Medicare Pay for Ambulance Service?

Most people want to know if their Medicare coverage will cover ambulance service long before they are even put onto a stretcher and wheeled into such a vehicle. In fact, most people do not worry about whether or not their insurance policy will pay for any of the cost of being transported in an ambulance until well after they have received needed treatment and have found themselves swallowed up by a month of bills. A person’s Medicare coverage may pay for ambulance services as long as certain conditions are met. A person must have original Medicare for the information listed below to apply to them.
Source: seniorcorps.org

Medicare Benefits and Cost

Posted by:  :  Category: Medicare

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

Video: How to Understand Medicare Plans

Medicare Plans to Grade Hospitals with Stars

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

Utah Medicare Supplements

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

Compare Medicare Supplement Plans

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

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

Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals

Many of the budget proposals and debt-reduction plans being considered by Congress and the Administration include proposals that would achieve substantial savings from the Medicare program over time. This brief features a side-by-side comparison of the key Medicare provisions in three major budget and debt-reduction plans:
Source: kff.org

3 Signs It Is Time for a Medicare Plan Checkup

Solution:  Again this happens most frequently with Medicare Advantage plans and Part D Prescription Drug plans.  Make sure you compare other plans when the 2014 AEP season opens October 1. At that point you can look at Medicare Advantage and Part D options.  If you have a Medicare Advantage plan you can also look at whether you can qualify for a Medicare Supplement plan.  The monthly cost may be higher but you may find that overall it will reduce your costs because it gives you access to your preferred doctors and facilities and doesn’t require copays.  Do the math to see how your costs overall compare.
Source: iquote.com

Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality

The American Medical Association has been urging Congress to eliminate the program when lawmakers complete the annual ritual of adjusting Medicare pay to physicians to avert massive automatic cuts. “To impose a program that takes money off the top of payments that have not kept up with inflation for more than 10 years will increase the migration of physicians into hospital settings, driving up overall Medicare spending in the process,” the AMA wrote in a letter to the House Ways and Means Committee in April.
Source: kaiserhealthnews.org

Medicare Open Enrollment 2013 – What you need to know

The short answer is, “it’s up to you”.  Medicare Advantage is similar to an HMO or PPO insurance plan.  Original Medicare (Part A and Part B) doesn’t cover everything.  One way to fill the gap in coverage is to sign up for a Medicare Advantage plan, which includes Parts A and B, but also includes additional coverage, and is administered by a private insurance company.  The other way to fill the gap in coverage is to sign up for a Medicare Supplemental Insurance Plan, also known as Medigap.  We’ll provide more details on Medigap in an upcoming post.  Medicare Advantage plans do differ, so make sure you compare the benefits.
Source: betteboomer.com

Medicare Open Enrollement in NJ and PA

David brings over 12 years of experience in health insurance advocacy and coordination. David previously served in a supervisory capacity including acting director with the Camden County Department of Health and Human Services, Division of Senior and Disabled Services. David also was the coordinator of the State Health Insurance Assistance Program (S.H.I.P.) and a certified counselor assisting in the education and implementation of Medicare, supplemental health insurance and prescription drug coverage to the senior and disabled population.
Source: rothkofflaw.com

Remember to Compare Medicare Part D Plans to Cut Costs

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Source: moneyning.com

Medicare patients should be wary of drug plan hoops

Posted by:  :  Category: Medicare

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“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

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

The Medicare Prescription Drug Benefit Fact Sheet

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

Medicare and Health Insurance, What is Covered, Medicare Supplement

Medicare Part D pays for prescription drugs. This plan covers both generic and brand name prescription drugs. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year during the open enrollment period, you have the option to change your drug plan to fit your specific needs. Perhaps when you turned 65 you did not have need for extensive coverage, but as you get older and your needs change, this coverage can be increased as necessary.
Source: bradeninsurance.com

Health Subcommittee Examines Proposals for Reform and Improvement of the Medicare Part B Drug Program

Reimbursement rates under Medicare Part B have caused the shift of some patient populations, including those with cancer and other rare diseases, from physician offices to hospital outpatient centers. The reimbursement shift, as coupled with community cancer centers closing, has caused an increased cost to the Medicare system and patients. As Brooks added, “Medicare payments for chemotherapy administration services in hospital outpatient settings have more than tripled since 2005, while payments to community cancer clinics have actually decreased by 14.5 percent.”
Source: house.gov

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

The ABCs and Part D of Medicare

Part A and Part B do not cover all costs. Retirees must still pay coinsurance and deductibles. For example, Thomas would need to pay a $1,184 deductible to a hospital before Part A insurance kicks in. Original Medicare has a 20% coinsurance expectation for the Part B costs of paying doctors and nurses for the care they provide. As you can imagine, this 20% can become a hefty bill when expensive procedures are required. To bridge these gaps, private insurers offer 10 different Medigap plans designed by the federal government to supplement Original Medicare.
Source: marottaonmoney.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

Survey Finds Seniors Satisfied With Medicare Part D

Politico Pro: Survey: High Satisfaction With Medicare Part D The debate may be raging over Medicare in the race for the White House — but a new survey points out that one part of it, Medicare Part D, has both positive results and bipartisan support. And health experts from Third Way, the Galen Institute and the Healthcare Leadership Council say the program’s success means that during sequester negotiations lawmakers should keep their hands off the Medicare prescription drug benefit. David Kendall, senior fellow for health and fiscal policy at Third Way, said on a call with reporters that the Medicare prescription drug benefit was a key example of successful bipartisanship because it was “enacted by Republicans and perfected by Democrats” (Smith, 10/3).
Source: kaiserhealthnews.org

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

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

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

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August 15, 2013

Social Security uses marriage information to check on available benefits

Posted by:  :  Category: Medicare

You can apply for spousal benefits the same way that you apply for benefits on your own record. That means you can apply for reduced benefits as early as age 62 or for 100 percent of your full retirement benefits at your full retirement age. The benefit amount you can receive as a spouse, if you have reached your full retirement age, can be as much as one-half of your spouse’s full benefit. If you opt for early retirement, your benefit may be as little as a third of your spouse’s full benefit amount.
Source: mysanantonio.com

Video: Medicare Questions – Company Benefits & Credible Coverage for Medicare Part D

7 Common Questions (and Answers!) about Medicare

Debbie,.. I too feel very blessed. My new coverage includes eye exams, hearing and DENTAL! What concerns me is the rumor that those with Medicaid are going to have to pay their deductables as of January 2014. I’m not sure what that means yet. I don’t take alot of meds, but medicare has stopped paying for infusion therapy for Fibromyalgia and they won’t pay for hormone therapy cream but they will pay for hormone pills. Of course, which have terrible side affects. NATURALLY! leave it to the government to allow a medication that will cause breast cancer= MORE MONEY for drug companies until you die!! With my new meds, I am looking at about $5.30 every three months. If I was able to get my three therapy treatments that I desperately need, I would be paying an extra $410 per month. It makes no sense that the government allow or condone complete alternative health care, nor will insurance plans pay for logical wellbeing healthcare. It’s all about the upper crust who can afford the out of pocket expenses, verses those who can’t. You stay in pain longer, but you are also on the preplan for early departure from life. Medicare is not a product for overall wellbeingness and health.
Source: care2.com

Liberals Oppose Increasing Medicare Eligibility Age

The Hill reported that, at her weekly news conference, Pelosi was even more dogmatic.   “Don’t even think about raising the Medicare age,” she said.  “We are not throwing America’s seniors over the cliff to give a tax cut to the wealthiest people in America.” Pelosi must be the only person in the entire country who doesn’t know that, as part of a package to increase taxes on the wealthiest people, spending cuts in entitlement spending would be included as a way of keeping Medicare solvent.   As for Pelosi’s claim that an increase in the Medicare eligibility age would “have little to show for it in long-term deficit reduction,” you would think the House Minority Leader would consult the facts before making such a public statement.   The Congressional Budget Office calculates that, just a two year age increase, from 65 to 67, would result in a net savings of $113 Billion over the next decade. But maybe $113 Billion is “little” to Pelosi. Another issue of The Hill stated that the outgoing chairman of the House Democratic Caucus, Rep. John Larson (CT), said that Democrats are willing to cut more from entitlement programs, but warned that direct benefit cuts “would be a big leap for our caucus.” That’s the point. If the eligibility age is not increased, the alternative will be to ration benefits, i.e. deny high-cost treatments to seniors nearing the end of their lives.   There is already a dangerous mechanism in place for doing this in Obamacare, the Independent Payment Advisory Board (IPAB), which former Congressman Dick Gephardt (MO) (pictured), Pelosi’s predecessor as House Democratic Leader, said would have “devastating consequences for the seniors and disabled Americans.” To prevent IPAB from being used for euthanasia for the elderly, it is absolutely essential the eligibility age for Medicare be increased. Of course, special provision must be made for those persons whose poor health requires them to retire sooner than provided by law and to receive Medicare benefits upon retirement. The Social Security Administration states that the life expectancy in the U.S. is now 83 for men and 85 for women. There are many good reasons to raise the eligibility ages for both Social Security and Medicare. The previous issue of What’s Happening with Seniors Benefits: How to Save Medicare—And How Not To The previous issue What’s Happening with Conservatives and the Tea Party: GOP Lost 174 State Legislative Seats   Previous issues of both newsletters. Follow Art Kelly on Twitter @ArthurKellyJr
Source: 60secondactivist.com

Compliance Check: Medicare Part D Annual Disclosure Notice Requirement

aetna benefits survey benefit trends Blue Shield California california public employees retirement system City Ordinance commuter benefits compliance Contract Negotiations CoveredCA covered california current-events employee benefits employee health benefits exchange FMLA FSA Plans government HDHP healthcare reform Health Care Security Oridance Health San Francisco Health Savings Accounts High Deductible Health Plan HSA human resources IRS kaiser family foundation leave of absence medical plan costs medical plan design medicare medicaid military Network Update notice requirements Out-of-network Paid Time Off politics PPACA pre-tax pregnancy private medical insurance public health care exhange retirement plans Safe Time San Francisco Seattle SHOP Sick Time state health exchange
Source: wordpress.com

CMS gets good report card on improving its Medicare eligibility IT

Users of the system interviewed by GAO said they were satisfied with the system, which had not been up to snuff over the past few years. According to GAO, CMS has resolved the operational issues they had in 2010 and 2011. System performance reports for the first six months of 2012 showed that the average response time per transaction was less than three seconds. Users told GAO that the upgraded CMS system now provides more complete information and reliable service than other systems that they use to verify eligibility with commercial health insurers.
Source: ihealthtran.com

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August 15, 2013

Sr Contract Monitoring Analyst

Posted by:  :  Category: Medicare

Flickr

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Five to seven years experience in quantitative business analyses and statistical modeling (preferably healthcare related).Proven analytical experience using Enterprise Guide SAS, database query capabilities and ability to evaluate data at various levels of detail (preferably Enterprise Guide SAS) *Subject Matter Expert on Medicare Part D and CMS requirements and Pharmacy Benefit Manager (PBM) technical and operational experience is preferred
Source: kdnuggets.com

Video: Rhode Island Medicare Advantage Plans

Budget Vote Doesn’t Mean Cicilline Isn’t Progressive

38 Studios Abel Collins ACLU ALEC Angel Taveras Anthony Gemma Brendan Doherty budget CD1 Central Falls chafee christmas cicilline Civil Rights / Liberties Congress David Cicilline Democrats Economy ed deform Education Elections General Assembly Gina Raimondo gist Gordon Fox Income Inequality jon brien Labor lgbtq Marriage Equality Mitt Romney necap Obama pension Politics projo Providence raimondo Republicans Rhode Island ride Sheldon Whitehouse state house tax equity Taxes Unemployment URI Woonsocket wpri wpro
Source: rifuture.org

R.I. Firm Settles Medicaid Fraud Claims In Connecticut For $9.9 Million

The state’s complaint alleges that Anusavice also violated his program exclusion by actively managing the practices, which received millions of dollars in Medicaid reimbursements. Although Anusavice was no longer licensed by any state to practice dentistry, he was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.
Source: ctwatchdog.com

Nice Medicare Part D Cost photos

Rockefeller Introduces Legislation to Protect Almost 90,000 West Virginia Seniors and Reduce Deficit By 1.2 Billion Image by SenRockefeller Senators Jay Rockefeller (D-WV), Bill Nelson (D-FL), Amy Klobuchar (D-MN), Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Barbara Boxer (D-CA), Sherrod Brown (D-OH), Dick Durbin (D-IL), Al Franken (D-MN), Angus King (I-ME), Patrick Leahy (D-VT), Jeff Merkley (D-OR), Jack Reed (D-RI), Bernie Sanders (I-VT), Brian Schatz (D-HI), Jeanne Shaheen (D-NH), Debbie Stabenow (D-MI), Tom Udall (D-NM), and Sheldon Whitehouse (D-RI) today introduced legislation to significantly reduce the deficit, better protect seniors’ health care, and reduce Medicare Part D drug costs for taxpayers.
Source: coloradomedicaremedigap.com

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August 15, 2013

HIPAA/COBRA/MEDICARE *Upcoming Seminars*

Posted by:  :  Category: Medicare

Kate Bardsley, Association Manager of MAIA’s sister association MassAHU, came to me this morning with some information for MAIA members. Actually, she must have been in early, because she tracked me down in the hallway while I still had my coat on. But that’s the way Kate is…she gets things done, no matter the time or place!
Source: wordpress.com

Video: Dunedin Library Hosts Medicare Seminars

Medicare Seminars For Senior Market

Only a small percentage of our total Medicare Advantage certified agents have success with seminars. Most them have deep roots in their markets or already have large blocks of enrollments that need to move. The key is getting seniors to attend your seminar and that takes money. Medicare Advantage companies can help you with CMS approved marketing material and your FMO should be able to connect you to the right departments at the companies. If seminar selling was easy, every agent would do them. The presentation is the easy. Getting people to attend is hard part. Also – If you end up having seminars, make sure you file them with the Medicare Advantage plan you are presenting. There are several CMS rules around seminars and the company will be able to point you in the right direction.
Source: insurance-forums.net

Burmese Community Activities and Events: No Family Left Behind Medicare Seminar, Dec 12, 2010

Aug 24, 2013 – Dhamma Aye Yeik Monastery Waso Robe Festival, Oakland Aug 24, 2013 – First Burmese Baptist Church of San Francisco Fundraiser, Daly City Aug 25, 2013 – Ashin Zawana Mettashin Dhamma Talk, Fremont September 14, 2013 – The Trees San Francisco Concert, San Francisco September 14-15, 2103 – 6th Annual Myanmar Film Festival LA 2013, Monterey Park September 22, 2013 – Theravada Dhamma Society 6th Annal Naibban Zay, Daly City
Source: blogspot.com

Emeritrust Medicare Educational Seminar Presentation Ver. 5 1.17.2010

Emeritrust Benefits provides a Medicare educational seminar to help explain what Medicare does and does not cover. We also explain what other types are available including Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D drug plans.
Source: slashdocs.com

Need Medicare Answers? Check Out Eau Claire County Seminar 

badgercare plus Better Business Bureau charity scams credit card fraud credit card scams election fraud false claims act fraud fraud alert newsletter Frauds healthcare reform identity theft job scams medicaid fraud Medicare medicare fraud medicare overbilling medicare part D medicare reform mortgage fraud phishing scams podcasts prevent medicare fraud scams storm chasers storm scams telephone scams Training volunteer voter fraud wisconsin bbb wisconsin better business bureau wisconsin check fraud wisconsin child care fraud wisconsin election fraud wisconsin fraud wisconsin head start fraud wisconsin medicaid fraud wisconsin mortgage fraud wisconsin scam wisconsin scams wisconsin smp wisconsin smp training wisconsin unemployment benefits wisconsin unemployment fraud
Source: wisconsinsmp.org

Weekly Update: Beginner’s Guide to Medicare Seminar

March 25, 2010 This seminar is intended for new providers or providers with new office staff and will provide an overview of Medicare. A variety of topics will be covered including the four parts of Medicare, how to determine eligibility and claim submission requirements.   For more in formation, click here.
Source: blogspot.com

11/2: Medicare Reform Seminar

Waterside Villas is hosting a Medicare Reform seminar on November 2 at 10:30 a.m. and again on Nov. 4 at 2 p.m.  This FREE program is designed to help seniors understand the complexities involved in health care reform.  The discussion will include an overview of Medicare, trusts, and long term care insurance.  Continental breakfast and light lunch will be served.  Please RSVP by calling (609)409-0018. 
Source: aplaceformom.com

Healthcare Reform Seminars, June 4 and 10, 2010

Law Firm Sonnenschein Summary, with an excellent topical summary of affected areas. http://www.sonnenschein.com/docs/Health_Care_Reform_Side-by-Side.pdf Kaiser Family Foundation on Reform, perhaps the best summaries of all non-tax aspects of the legislation. http://healthreform.kff.org/ (generally) The Best Summary! http://www.kff.org/healthreform/upload/8061.pdf Kaiser Family Foundation Subsidy Calculator where you can determine the government subsidy to individuals to purchase insurance http://healthreform.kff.org/Subsidycalculator.aspx Kaiser Family/Alliance for Health Reform Podcast on Private Insurance Changes, a superbly done summary of what the insurance reforms really mean. http://www.kff.org/healthreform/ahr043010video.cfm Controlling Health Care Spending in Massachusetts: An Analysis of Options http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/09/control_health_care_spending_rand_08-07-09.pdf
Source: typepad.com

A FREE Seminar on Medicare Supplemental Coverages

There are two different seminar times available. If you have any questions or would like to register, please click on the seminar you want to attend on below and email us your name and phone number. You can also register by calling Cinda at (810) 714-4504.
Source: wordpress.com

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August 15, 2013

Provider idenification Numbers 

Posted by:  :  Category: Medicare

NPI Number-National Provider Identifier Number was created in order to simplify all the different ID number for each insurance.  Effective May 23, 2007  all providers had to have an NPI number to bill insurance and also to identify themselves as referring physicians.  A new uniform billing form was created to accommodate these new NPI numbers.(see Uniform Billing Forms).  The doctor or group associated with the NPI will be the address in box 33 a of the CMS form/ or for a facility box   of the UB-04 form.  that is who will receive the insurance payment.
Source: survivinghealthinsurance.com

Video: Live Webinar: DOS & DON’TS of Medicare part B Enrollment of New York & New Jersey

Cash Based Pelvic PT Clinic – Interview of Emily Wegmann MPT, OCS

Hi Ann and Teresa, These are great questions regarding Medicare and the fee schedule, and a topic often discussed in these and other forums. We will do our best to answer them fully! Can non-participating providers accept payment up front? Yes, non-participating providers are technically able to collect payment from patients at the time services are rendered. The claim is submitted to Medicare, and Medicare reimburses the patient directly and passes on the claim a secondary insurer, if applicable, for additional direct patient reimbursement. The patient is responsible for his or her deductible and any allowable charges not paid for by Medicare and other insurance providers. Sounds simple (kind of); HOWEVER, here are the things to be aware of when determining payment: Fee schedules, limiting charges and the like: We are not contracted with any insurance provider and are not bound by contracted fee schedule amounts with private insurers. Non-participating provider for Medicare are able to have a separate and distinct fee schedule for Medicare patients based on the physician fee schedule for non-participating providers (see below on how to determine the fee schedule in your region). The separate Medicare fee schedule cannot exceed the standard fee schedule. Not surprisingly, non-participating and participating Medicare providers have different fee schedules. If you consider this route, make sure you have the CORRECT fee schedule for starters. The non-participating fee is determined by your intermediary (if you live in NC, SC, VA or WV, you can find the fee schedule here on the Palmetto/GBA website; if you live in CA, HI, or NV find it here. See the follow-up answer for additional links if you reside in a different state). Non-participating providers are permitted to charge up to 115% of the designated fee per each code. When you look up the fee schedule for your region, you will find the fee assigned to each CPT code as well as the limiting charge (the highest allowable charge) for each code. Sounds easy, right? Just find the fee, tack on an additional 105-115%, and you are ready to go. Not so fast. MPPR (Multiple Procedure Payment Reduction): The MPPR, simply put, means that the highest billable unit charged is reimbursed at 100% of the allowable amount, and that the values of other codes charged during the same visit will be reduced when more than one code is billed on the same date. Currently, the reduction is 20% for those in private practice but is slated to increase to 50% in April. The APTA website does an excellent job of defining the MPPR and discussing the implications if the proposed 50% reduction goes into effect. Importantly, the patient may NOT be billed for the difference between the fee and the reduction created by the MPPR. This means another calculator and adjustment to the fee before you charge the patient. Secondary Insurance The good news is that Medicare automatically pushes any claims directly to the secondary insurance provider when applicable. The bad news is that there is another calculation to be made if a patient has secondary insurance. There is another calculator that further adjusts the fee amount if the patient has another insurer. At last inquiry, it was stated in these terms: ‘Using this calculator is an estimate, not a guarantee that the fee amount will be what we determine when the claim is processed.’ Bottom line: We are able to collect payment from Medicare patients up front as non-participating providers, but must consider at least three different calculators to determine the exact amount to bill the patient at time of service. Even with all three calculators it is difficult to determine the exact cost the patient would owe up front. For this reason, we have decided to forgo collecting cash at time of service and are now billing Medicare with traditional billing methods (still as non-participating providers). Once the claims are processed, we are informed of the remaining patient responsibility and bill them accordingly. We discuss this openly with patients when they call, let them know that there will be a component of payment that they will be responsible for and answer any questions. It is not ideal however it allows us to continue to work with these patients and make sure that we are charging the patient appropriately. Sound complicated? Well, we think it is. We are continuing to evaluate the best possible ways to accept all patients in a cash based model. In an ideal world, physical therapists would be able to opt out of Medicare just as physicians do. Ann, we are including a link to your blog (http://www.webpt.com/blog/post/medicare-issues-facing-cash-based-pts) for those who want to learn more about to take action to allow physical therapists to opt out and provide services to Medicare patients in a cased based model. Best, Emily & Sarah
Source: drjarodcarter.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Chest X

Denial Reason, Reason/Remark Code(s) M-80, CO-18 – Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate CPT codes: 93010, 71010, 71020 Resolution/Resources First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA Online Provider Services (OPS) tool or by calling the Palmetto GBA Interactive Voice Response unit (IVR). Online Claim Status Verification through OPS
Source: medicarepaymentandreimbursement.com

Does medicaid cover adderal xr in michigan // Tomar muchas pastillas de diazepam puede matar

Information about plans, contacts, publications, health care fraud and nursing homes. Medicare and Medicaid Questions including. Ranking State Medicaid Programs – Public. Read the latest News about Finger Pro’s Music Apps for iPhone, iPod touch, and iPad. Federal investigators say Florida officials are violating federal law by unnecessarily warehousing hundreds of children with disabilities in geriatric nursing homes. Medicare and Medicaid Questions including. Tuesday, January 29, 2013. Last updated: Tue, Jan 29. KHN Original Reporting & Guest Opinion. Kidney Donation Over Age 70? Desperate Patients Saying, ‘Yes, Please’ Daily Report – Kaiser Health News Finger Pro – Music Apps for iOS Unsettling Scores A Ranking of State Medicaid Programs. April 2007. Annette B. Ramírez de Arellano, Dr.PH. Sidney M. Wolfe, M.D. Public Citizen Health Research Group Palliative care is medical care provided by physicians, nurses and social workers that specializes in the relief of the pain, symptoms and stress of serious illness. Medicare and Medicaid Questions including “Does Medicare cover pregnancy expenses” and “Is there medicare PTAN or Provider Transaction Access Number look up website” November 2012 Medicare Part D Coverage of Benzodiazepines and Barbiturates 01/01/2013. As of January 1, 2013, Medicare Part D plans will cover benzodiazepines and
Source: freeblog.hu

今週土曜は記念Suica&全国ICカード発売!

■発売箇所(合計31箇所) 【東京都】   東京駅・品川駅・新宿駅・上野駅・池袋駅・立川駅・八王子駅・錦糸町駅 【神奈川県】   横浜駅・川崎駅・大船駅・小田原駅 【埼玉県】   大宮駅・浦和駅・熊谷駅 【千葉県】   千葉駅・船橋駅・津田沼駅・新浦安駅・松戸駅 【群馬県】   高崎駅・前橋駅 【栃木県】   宇都宮駅 【茨城県】   水戸駅・土浦駅 【山梨県】   甲府駅 【宮城県】   仙台駅 【福島県】   福島駅・郡山駅・いわき駅 【新潟県】   新潟駅
Source: pkan.net

RAIL ROAD MEDICARE REQUESTS FOR PROVIDER’S PTAN#

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

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August 15, 2013

Section 111 Medicare Secondary Payer Reporting Update

Posted by:  :  Category: Medicare

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The Centers for Medicare and Medicaid Services (“CMS”) announced an option which will allow for payment of a simple fixed percentage on small dollar liability insurance or self-insurance settlements for physical trauma-based injuries. Effective November 7, 2011, in cases where the settlement is $5,000 or less, a Medicare beneficiary may opt to resolve Medicare’s recovery claim by paying Medicare 25% of the total settlement instead of using the standard recovery process.
Source: dritoday.org

Video: Section 3:How Do I Pay For Nursing Home Care

MMSEA Section 111 Reporting for All Insurance Types :Gould & Lamb

About the Author: John Miano is the Manager of Reporting Services for Gould & Lamb, LLC. His primary responsibility is directing the implementation of CMS Section 111 reporting programs for our clients. He has over 20 years experience in the Property and Casualty Insurance Industry and is currently an active committee member of the International Association of Industrial Accident Board Committees (IAIABC). He is also a former Executive Board Member of the Association of Workers Compensation Claim Professionals (WCCP) and is a Board Certified Workers Compensation claim adjuster (CWC).
Source: themedicarecomplianceblog.com

Medicare Section 111 Reporting Requirements

Group health plans must report to the Centers for Medicare and Medicaid Services (CMS) Social Security Numbers or Medicare Insurance Claim Numbers for employees and their covered family members who might have Medicare coverage in addition to coverage under the employer group health plan.  Many employers with fully-insured health plans have been contacted by their insurers to collect SSNs and HICNs for their participating employees.  Self-funded plans may have their own reporting requirements.  The reporting, required under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, helps CMS identify Medicare-covered individuals with group health plan coverage that should pay claims primary to Medicare.
Source: basusa.com

MMSEA Section 111 Mandatory Insurer Reporting Updates : Life Sciences Legal Update

Second, CMS has posted revised guidance pertaining to liability insurance (including self-insurance) responsible reporting entities (RREs) where the claims involve exposure, ingestion, and implantation issues. In the guidance, CMS explains its policies for claims involving exposure, ingestion, and implantation. Specifically, CMS discusses when Medicare will, and will not, assert a recovery claim against the settlement, judgment, award, or other payment, and when the MMSEA, Section 111 mandatory reporting rules must (or need not) be followed. CMS also provides examples of various factual scenarios involving exposure, ingestion, and implantation, and discusses how its policies will be applied to each.
Source: lifescienceslegalupdate.com

MSPRC Posts Revised Section 111 Implementation Schedule

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

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
Source: crowell.com

NGHP Section 111 Reporting Mid Year Review :Gould & Lamb

Earlier this year, the Department of Health and Human Services (DHS) issued a Medicare Learning Center ‘News Flash’ advising Medicare fee for service providers on proper procedures for identifying primary payers and making correct and timely billing submissions to Medicare. Despite this notification and training of CMS contractors, there remain widespread reports of injured parties contacting insurers or their agents seeking remedy for affected Medicare treatment and services disrupted by NGHP Section 111 reporting. Along with the administrative burden on the industry, there is frustration over the inability to affect resolution.
Source: themedicarecomplianceblog.com

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