Medicare Payment to ASCs: Big Trends & Impact Factors

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Earlier this year, CMS published chargemaster data from hospitals for top procedures, igniting controversy as local and national news media compared prices and sought an explanation for the difference. Since the chargemaster data represents what the hospital bills — not necessarily what it actually receives — for a treatment, the usefulness of this data is questionable. However, some in the ASC industry feel surgery centers have benefited for price transparency and stand to gain if more prices are made public.
Source: beckersasc.com

Video: Update on Medicare Reimbursement

Lobbying Congress for Medicare Reimbursement

This week, the full Energy and Commerce Committee, of which Walden is a ranking member, will consider new legislation that would provide stable payments for the first two years with annual increases after that. The legislation would phase in a new system that would remove some of the incentives for fraud and reward providers who offer quality care for less, Malcolm said.
Source: thelundreport.org

Rising Healthcare Costs, Medicare Reimbursement Cuts Fuel Demand for Affordable In

These costs are proving to be cost-prohibitive for many families. Ac­cording to a 2012 report by The Schwartz Center for Economic Policy, 75 percent of workers between the ages of 50 and 64 had less than $30,000 in their retirement accounts in 2011. A 2011 report by the Wall Street Journal found the typical American household nearing retirement with a 401(k) savings account had less than one quarter of what was re­quired to maintain their current standard of living.
Source: myprimetimenews.com

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

Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions

In the third round of the program, starting in October 2014, Medicare is increasing the final maximum penalty to a 3 percent payment reduction for all patient stays. Also that year, Medicare plans to consider readmissions for more conditions, including chronic lung disease and elective hip and knee replacements. Health experts have also designed a way to measure all of a hospital’s readmissions, and that may ultimately be used for the penalties. In addition, several of Medicare’s other experiments in alternative payment plans, including accountable care organizations and bundled payments, aim to give hospitals full financial responsibility for patients.
Source: kaiserhealthnews.org

Westbury Community Hospital to Close Without Medicaid/Medicare Reimbursement

The Centers for Medicare and Medicaid Services (CMS) is withholding $430,000 for payments it claims are for “incarcerated” patients.  Westbury has provided reams of documents and affidavits proving that Westbury does not treat incarcerated patients but CMS refuses to pay the hospital, has given officials conflicting advice on how to clear up the problem and will not release the funds while Westbury is appealing.
Source: newswirehouston.com

Medicare Physician Payments: Reforming the Sustainable Growth Rate

The language in the House discussion draft—linking Medicare physician pay to compliance with government-established guidelines—accelerates a troubling trend reinforced by Obamacare itself. The national health care law, with 165 provisions affecting Medicare,[23] not only retains the SGR, but, like the SGR, it also imposes a hard cap on the growth of all Medicare spending. It creates an Independent Payment Advisory Board (IPAB), which will have the power to enforce the cap, and recommend even more Medicare reimbursement cuts for physicians and other medical professionals. It creates new institutions to change Medicare payment and delivery through administrative action, such as the Center for Medicare and Medicaid Innovation, with demonstration programs designed to end traditional fee-for-service (FFS) payments. Beyond these new institutions, the health law creates new Medicare “quality” programs and extends the Physician Quality Reporting Initiative (PQRI), which will enforce new bonus and penalty payments for physician compliance. As the Congressional Research Service (CRS) reported in its first evaluation of the statute, the new law “makes several changes to the Medicare program that have the potential to affect physicians and how they practice in ways both small and large, immediately and over time.”[24]
Source: heritage.org

Health Insurance in NYC and Tri

Posted by:  :  Category: Medicare

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The Annual Enrollment Period (AEP) is fast approaching. It starts October 15, 2013 and runs to December 7, 2013. At this time those who are enrolled Medicare can review their coverage and switch plans, if need be, to suits any changing needs or conditions. This is a good time to begin thinking about seeking out the advice of a specialist in Original Medicare or all the Medicare Advantage (Part C), Medicare Prescription (PDP or Part D) and Medicare Supplement or Medigap plans available in your county. The plans do vary from county to county and each health insurance company offering plans has different benefits although they all match Medicare coverage or better. I am a licensed health insurance agent in the states of New York, New Jersey and Connecticut. I am appointed with Aetna Medicare and AARP United Healthcare in all 3 states. I am appointed with Empire Blue Cross & Blue Shield in New York and Anthem Blue Cross & Blue Shield in Connecticut. I offer no obligation, no pressure advice and I never charge a fee for my services. Kirk Devereux Genesis Business Capital Senior Services Specialist Cell: 914-393-3872 kirkdevereux@gmail.com www.kirkdevereux.com
Source: blogspot.com

Video: Occupy activists observe 47th Anniversary of Medicare – NYC

New Yorkers Celebrate Medicare’s 48th Anniversary and Lobby for Improved Medicare for All!

In addition to the home-district visits to Representatives Jeffries, Lowey, Maloney, and Velazquez, allies were calling and meeting Members of Congress in their offices in Washington D.C. in preparation for the Congressional Briefing on HR 676. Representatives Rangel and Clarke were thanked for their endorsement of HR 676, and asked to show more leadership to protect and expand Medicare.
Source: pnhp.org

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

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

What Podiatry Services Are Covered By Medicare?

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.
Source: healingfeet.com

Represented a nursing home investigated for Medicare Fraud by the New York Office of Inspector General

Federal Defense Attorney in New York City Federal Corporate Fraud Federal Bank Fraud Federal Healthcare Fraud Federal Medicaid Fraud Federal Insurance Fraud Federal Money Laundering Federal Bankruptcy Fraud Federal Mortgage Fraud Federal Mail and Wire Fraud Federal Computer Crimes Federal Tax Fraud Federal Drug Crimes Federal Sex Crimes Federal Weapons Charges International Extradition Federal White Collar Crimes Guide
Source: nycfederaldefense.com

Medicare beautiful pictures Nyc

About advice Beautiful care center Cheap children compare Cool coverage current Determinants dream events expatriates family food Forum Georgia habits health healthy heart Holistic images Indiana individual Information insurance jobs Medicare Mental Nice Obama photos pictures Plans Quotes reform Tasty Tips Video Washington Wellbeing Wellness
Source: elizemorton.com

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

According to the Complaints and Settlements filed in this case, the hospital double-dipped by billing New York and the federal government for psychiatric services provided by its physicians.  St. Luke’s-Roosevelt billed out-patient psychiatric services to Medicaid as a rate-based service, which included the care provided by the physician and all other related costs. At the same time, SLR billed the state and federal governments on a fee-for-service basis for the same care provided by the physician. Also, St. Luke’s-Roosevelt sought and received reimbursement from Medicare for non-reimbursable costs for outpatient psychiatric visits. As a result, the Hospital received Medicare and Medicaid payments that it was not entitled to receive.
Source: seniorlivingcare.com

Hospitals’ Medicare funds at risk

“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a press release when the agency launched the initiative last year. “Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”
Source: thenewyorkworld.com

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

California Healthline: Changes Set Stage For ‘Shakeout’ Of Medical Suppliers, Services Shifts in contracting practices — part of the trickle-down effects of health care reform — are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. … Bob Achermann, executive director of the California Association of Medical Product Suppliers … predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the “thinning of the herd,” as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal — California’s Medicaid program — from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).
Source: kaiserhealthnews.org

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: How to Understand Medicare Plans

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 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

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

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

Medicare Advantage Plans: Are They For You?

To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: marottaonmoney.com

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

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August 16, 2013

Ohio Consumers for Health Coverage Statement on Raising of the Medicare Eligibility to Age 67

Posted by:  :  Category: Medicare

Would yield only $5.7 billion in actual federal savings in 2014 when the costs of federal ubsidies for 65-66 year olds buying health coverage in the Exchange is considered, along with the federal government’s contribution to Medicaid for persons newly eligible under the Affordable Care Act and the loss of Medicare premium receipts. This is approximately one percent of the total annual cost of Medicare.
Source: progressohio.org

Video: FOX NEWS: McConnell To Democrats Raise eligibility age for Medicare

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

Speaker Doesn’t Foresee Increase In Medicare Eligibility Age This Year

CQ HealthBeat: Boehner Says Medicare Eligibility Age Issue Can Wait Until Next Year House Speaker John A. Boehner indicated Tuesday that he would not insist on raising the Medicare eligibility age as part of a fiscal cliff package and that the issue could be addressed next year as part of a larger overhaul of entitlement programs. At a morning news conference, the Ohio Republican was asked how strongly he feels that the Medicare eligibility age needs to be part of a deal. Although President Barack Obama entertained the idea during debt limit negotiations in 2011, Democrats in both chambers have expressed strong opposition to the change over the past few weeks. “That issue has been on the table, off the table, back on the table. It’s an issue for discussion. But I don’t believe it’s an issue that has to be dealt with between now and the end of the year,” Boehner said. “It is an issue, I think, if Congress were to do entitlement reform next year and tax reform, as we envision, if there’s an agreement that issue will certainly be open to debate in that context” (Attias, 12/18).
Source: kaiserhealthnews.org

Ohio Health Policy Review: Ohio Medicare

The federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Massachusetts and Ohio: Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

The Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. CMS also has signed an MOU with Washington to test a managed fee-for-service model. These three year demonstrations will introduce changes in the care delivery systems through which beneficiaries presently receive services and in the financing arrangements among CMS, the state, and providers.
Source: kff.org

What Raising the Medicare Eligibility Age Means

Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

New changes Ohio Medicare

Explaining New dates for changing your Ohio coverage. We now have more time to choose and join a private health or drug plan when the annual open enrollment period gets an earlier start than usual in the fall. This year, it will kick off on Oct. 15 and wrap up on Dec. 7. If you want or need to change your private Medicare Advantage health plan, there’s a new annual “disenrollment” period allows you to switch back to Original Medicare and a drug plan between January 1 and February 14. This replaces a January-to-March enrollment period when you could switch between Original Medicare and the Medicare Advantage program or move from one private plan to another.  The best way to understand what’s new is to refer to your “Medicare and You 2011” handbook, which you should have received by mail this fall. If you still need one, call 1-800-MEDICARE and request a free copy, or visit our guidebook page and download it.
Source: ohiomedigapinsurance.com

Daily Kos: Meet the real death panelists

95 Percent of Congressional Republicans. Every single Republican representative and senator voted against the Affordable Care Act before President Obama signed it into law in March 2010. Since January 2011, House Republicans have voted 40 times to repeal Obamacare. Were they to succeed, the GOP wouldn’t just be preventing up to 30 million more people in the U.S. from obtaining health insurance. All of the law’s reforms that ended the worst practices of the insurance industry—refusing to cover those with pre-existing conditions, using “rescission” to drop coverage for those who become sick, discriminating against women, setting annual or lifetime benefits caps and more—would return to torment American patients and their families. Three and a half years after Senate Minority Leader Mitch McConnell announced that the GOP’s 2010 midterm campaign slogan “will be ‘repeal and replace’, ‘repeal and replace,'” his party has failed on both counts.
Source: dailykos.com

Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

This issue brief compares demonstration programs in California, Illinois, Massachusetts, Ohio, Virginia, and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
Source: kff.org

Health Insurance for Ohio Dependents

For Ohio residents, the Federal law only requires health insurance coverage is offered to age 26.   However, the Ohio laws require coverage to age 28 or an extra two years provided the requirements mentioned above are satisfied.   Thus,  insurers offering group or family health insurance coverage in Ohio will need to abide by the state law from age 26 to 28 as of July 1.
Source: ohioinsureplan.com

The Net Effect of Raising Medicare’s Eligibility Age

Over the past week, Congress and President Barack Obama’s administration have continued their spar over the “fiscal cliff” — a series of spending cuts and tax hikes that will go into effect at the end of this year without a deal — and recently, groups have insisted raising the Medicare age should be part of the compromise. Sam Baker of The Hill reported House Speaker John Boehner (R-Ohio) and other congressional Republicans are demanding $600 billion in healthcare cuts. Raising Medicare’ eligibility age from 65 to 67 is a key proposal right now to help achieve those savings. In the long term, raising the Medicare age would save the federal government roughly $86 billion over six years, according to the Congressional Budget Office. Essentially, seniors aged 65 and 66 would be phased into Medicare, and in the mean time, they would be responsible for their own healthcare coverage for an extra two years through employers, individual plans or other government plans. In July 2011, The Kaiser Family Foundation also conducted a study on raising the age of Medicare eligibility, finding that it would save the federal government an estimated $5.7 billion in 2014 alone. However, with the savings, there would also be massive increases in out-of-pocket costs and employer retiree healthcare costs, according to the same Kaiser report. There could be new increased costs up to $11.7 billion for states, employers and individual seniors in 2014 through higher premiums on healthier, younger individuals and deferred treatment of chronic conditions. John McDonough, professor of public health at the Harvard School of Public Health, and others have said raising the Medicare age may save somewhat in the very short term, but it is only a “cost shifting” maneuver — i.e., other people will be picking up those “saved” costs. For example, the 65- and 66-year-olds may be more inclined to stay on employer insurance, meaning other workers and the employer would foot more of the bill. “Yes, fewer people in Medicare would lower costs somewhat, but these 65/66-year-olds, while the most expensive part of a working adult population, are also the least expensive part of the Medicare population,” Mr. McDonough wrote in a Boston Globe op-ed. “So the smaller number of Medicare enrollees left behind would have higher average costs per person, and those costs would increase Medicare premiums about 3 percent higher than they would otherwise be.”
Source: beckershospitalreview.com

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August 16, 2013

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

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

Video: A MARK LEVIN Masterpiece SCREW CHRISTIE! SCREW OBAMA-CARE! 3-1-13 JIM BRIDENSTINE (R-OK)

Universal Health Care Insurance Company Health Insurance Review

Under the Medicare PPO plans, policyholders may visit physicians, specialists, or hospitals within the PPO network or outside of the network. Benefits will vary depending on whether the provider is in or out of network. A provider directory can be provided to you by calling customer service or viewing it under the provider section on the company’s website.
Source: healthinsuranceproviders.com

Michael Gerson Pens a Modern Masterpiece

In cliff negotiations, Obama had one overriding goal: to make Republicans vote for rate increases on the wealthy. For 20 years the refusal to raise taxes has been one of the core issues that held together the disparate groups of the GOP. If Obama saw his job as bringing together a broad coalition to fix the long-term debt problem, he would have maneuvered Democrats to take on some of their core issues as part of a package, just as Republicans had to do. But Obama did not view his job this way. He wanted Republicans to swallow their humiliation pure.
Source: motherjones.com

Creating a Masterpiece: Madonna Rehab’s Team Composite Draws Together Multidisciplinary Documentation

Being a rehab hospital, Madonna has multiple care units—a traditional long-term acute care unit, a ventilator-assisted unit, traditional and extended-care nursing—and clinicians—physicians, nurses, therapists, case managers, and respiratory specialists, among many others—that must be accounted for in the documenting process. With disparate units and clinicians, there are disparate systems and an ongoing challenge of getting a “single source of truth” in real time, says Roberta Steinhauser, director of hospital applications at Madonna Rehabilitation Hospital.
Source: healthcare-informatics.com

Walking On Fire: The Rate And A Masterpiece

each Medicare RUG score. Our Director of Therapy and I work very well together to maximize our facility’s reimbursement rate – as our Medicare reimbursement rate testifies. The rate trend consistently continues upward. Second, yesterday one of our Corporate Support Specialists came to our daily stand-up meeting. She made a comment to all those present regarding the clinical care plans (like clinical action plans, sort of) I write (I also am the Care Plan Coordinator as well as the MDS Coordinator), calling one in particular “a masterpiece.” She requested that I print off a hardcopy of it for her. She also requested that I do a special in-service on the clinical issue the care plan addressed. I really appreciated her comment and public recognition on behalf of the corporation of my hard work and ability. I hope my approaching first yearly evaluation reflects these two good things that happened to me last week.
Source: blogspot.com

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August 16, 2013

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

Posted by:  :  Category: Medicare

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

Video: Medicare & You: Women’s Preventive Health

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

AMC Health helps Humana manage CHF in Medicare population

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

Sen. Rand Paul’s Medicare Reform Bill: $1 Trillion in Savings in 10 Years

First of all, medical insurance or medical care in the form of Medicare or anything else (SCHIP, Medicaid, Obamacare), is not the responsibilityof government. These are services that can and should be provided by the free market, just like dining, recreation, entertainment, and automobile repair are services provided by the market. Like all of the other welfare programs of the federal government, Medicare is an unconstitutional and illegitimate function of the federal government. It is socialistic and collectivist, it fosters dependency on the government, it shifts responsibility from the individual and his family to society and the state, it contributes to class warfare, and it crowds out real charity. It doesn’t matter if families and charities don’t pick up the slack (a very unlikely scenario) in the absence of government intervention in the market and someone goes without health insurance or health care. That doesn’t somehow magically make it the responsibility of government to provide someone with medical services. There is no right to health care that it is the duty of governments to provide or enforce.
Source: thenewamerican.com

Feds Get Tough On Medicare Fraud: Moratorium Bans New Healthcare Agencies In Miami, Chicago, And Houston

In 2012, 662 home health agencies were operating in Miami-Dade county, making its home healthcare agency to Medicare beneficiary ratio 1,960 percent greater than other counties. South Florida is notorious for being a hot-bed for Medicare fraud, in part because of several high-profile cases. In February, owners and operators of 2 Miami home health agencies were found guilty of participating in $48 million Medicare fraud scheme.
Source: medicaldaily.com

USDOJ: Michigan Physical Therapist and Home Health Agency Owner Pleads Guilty for Role in Medicare Fraud Scheme

A greater Detroit-area physical therapist who was also an owner of a home health agency pleaded guilty yesterday for his role in a $22 million home health care fraud scheme.   Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, United States Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office, and Special Agent in Charge Erick Martinez of Internal Revenue Service Criminal Investigation made the announcement. Hemal Bhagat, 32, of Troy, Mich ., pleaded guilty on August 14, 2013, before United States District Judge Bernard A. Friedman in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.  At sentencing, scheduled for November 12, 2013, Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine.   According to information contained in plea documents, Bhagat admitted that from approximately May 2009 through October 2011, he conspired with others to commit health care fraud through billing Medicare for home health care services that were not actually rendered and/or not medically necessary.  A licensed physical therapist, Bhagat began working in June 2009 for Troy-based Prestige Home Health Services Inc ., a home health agency owned by alleged co-conspirators.   In approximately August 2009, he and other co-conspirators became owners of Royal Home Health Care Inc ., a home health agency also located in Troy.     Bhagat admitted that his co-conspirators at Prestige and Royal paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare for services that were not provided to these beneficiaries and/or were not medically necessary.   He and his co-conspirators then created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided and/or were not medically necessary.   Bhagat’s role in creating the fictitious therapy files was to sign documents – including physical therapy evaluations, supervisory patient visits, and patient discharge forms – indicating that he and others had provided physical therapy services to particular Medicare beneficiaries, when in fact they had not.   Bhagat admitted to knowing that the documents he falsified would be used to support false claims to Medicare by his co-conspirators at Prestige and Royal.   He submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03. This case was investigated by the FBI, HHS-OIG and IRS Criminal Investigation and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Eastern District of Michigan.  This case is being prosecuted by Trial Attorney Niall M. O’Donnell, Deputy Chief Charles E. Duross, and Trial Attorney James McDonald of the Criminal Division’s Fraud Section.   Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov. Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Medicare Benefits and Cost

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

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August 16, 2013

Understanding The Medicare AEP Or Annual Enrollment Period

Posted by:  :  Category: Medicare

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The best way for individuals who have Medicare coverage to ensure that you receive the best value possible is to compare the different plans prior to switching during the 2014 Medicare AEP or Annual Enrollment Period. There are five parts of Medicare Insurance Plans which includes Parts A, B, C/Medicare Advantage or Medicare supplement, and D. The AEP does not apply to those individuals who already have Medicare supplement insurance. However, they are not restricted from switching during the AEP period, especially if they benefit from switching. Whether you currently have Medicare coverage, a Medicare Advantage (MA) plan, or Part D (prescription drug) coverage, you have one opportunity to make the changes you desire once per year during the AEP. That period is referred to as Medicare’s Annual Election Period or the Open Enrollment period. The AEP begins on the 15th of October and ends on Pearl Harbor Day, 2013 (December 7th). Any changes that you opt for will go into effect on the 1st of January, 2014. The AEP is beneficial to individuals covered by any Medicare insurance plans because it gives them the opportunity to make any changes they wish to their coverage every year if they so desire. This means that you can make these changes as your personal needs change. Therefore, you should at least examine those options prior to the AEP each year in order to ensure that you have a plan that effectively addresses those needs. You should ask yourself certain questions when reviewing your current coverages prior to the Annual Enrollment Period. For instance, in the past year, were you diagnosed with any type of long-term illness or medical conditions or did any of your prescription medications change this past year? If the answer to this is “YES”, you should take a closer look at your current coverage and consider making changes that you will benefit from during the AEP when you have the opportunity to do so. If you have a Medicare supplement plan than AEP is not for you. You have no restrictions on the time of year you can review your current plan and switch plans if desired. It is important to compare Medicare supplement plans to any Medicare Advantage plan so you understand the difference. Contacting an independent insurance agent that specializes in Medicare can help you make sense of it all. In closing, you should also remember that Medicare plans change with considerable regularity and so do their costs. As an example of this, the price of your current plan can decrease or increase each year. Or, if you have a Plan D prescription drug plan, medications may be added or discontinued on a regular basis. Finally, benefits may change frequently while other Medicare plans may stop offering coverage based on your geographic location.
Source: blogspot.com

Video: Medicare Part A Benefit Periods

Understanding Medicare Benefit Periods

Under Part A the patient must pay a deductible for every "hospital benefit period." Unlike most health insurance, where deductibles must be satisfied once every year, usually between January and December, there can be several Medicare hospital benefit periods in a calendar year. In 2010 the Part A deductible per benefit period is $1,100. A benefit period begins on the day a patient enters the hospital and ends after there has not been any hospital or skilled nursing care for 60 days. If the patient is discharged from the hospital or a skilled nursing facility and returns to either within 60 days of discharge, it is considered to be the same benefit period and there is no need to pay another deductible. However, if the patient remains out of skilled medical care (either hospital or skilled nursing facility) for more than 60 days and then goes back to the hospital, a new benefit period begins and another Part A deductible of $1,100 is required.
Source: texasagingnetwork.com

Obamacare implementation enters crunch period with delays

So sick of ya’ll, we did it ourselves, we didn’t get any help…..So you didn’t go through public education,you didn’t have the benefit of the best infrastructure in the world, have plenty of good jobs to go to and finally you aren’t arguably the most privileged group of people anywhere anytime. Now as you approach retirement you can relax, enjoy the time remaining without starving, without medical needs going unmet, and instead of 3 years left to enjoy it you probably have a decade or more. So instead of thanking your country of birth and the Progressive policies which have led to the creation of the middle class in which you live, you whine, piss and moan. You have lived under Democratic rule a majority of your life because after the Republicans caused the great depression it took a whole generation for you guys to see power again and the Republican Presidents that were elected couldn’t even come close today in your tea parties. You claim poor people complain but ya’ll act like whiney little spoiled angry brats. You are the epitome of I got mine (from the government) and now that I have F..k the rest of ya. Keep acting this way and there’ll be nobody around to wipe you whiney asses. Thank-you and have a nice day.
Source: nbcnews.com

Medicare A and B Cost and Benefits 2013

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

Medicare’s Role for Older Women

These gaps in benefits and cost-sharing requirements, together with spending for premiums for Medicare and supplemental coverage (described further below), can translate into high out-of-pocket expenses for people on Medicare.  On average, older women spent more on health care (including premiums) than older men in 2009 ($4,844 versus $4,230), a greater financial burden given their lower incomes.  Notably, older women spent more than twice as much on average for long-term services and supports (LTSS). (Exhibit 3) For all older Medicare beneficiaries, out-of-pocket spending escalates as they age, but women ages 85 and older have considerably higher out of pocket costs than older men, largely due to their higher health and social needs and greater use of long-term care services.  Often the need for these services comes at the time when women have fewer resources.   Among women ages 85 and over, out-of-pocket spending amounts and the share with low incomes are higher than for younger women and men of all ages on Medicare (Exhibit 4).
Source: kff.org

Three Midnight Rule For Medicare SNF Explained: Will CMS Pay?

Medicare will pay a portion of these SNF costs (the rest of which are picked up by patient’s supplemental policies) for a up to 100 days for every benefit period.   Once these days are used up,  the patient will be financially responsible for any other skilled nursing benefits until the next benefit period begins.  How does Medicare define a benefit period?   A benefit period ends when you have not been in a hospital or in a  SNF for 60 consecutive days.  Once a new benefit period begins you will need another three midnight stay to qualify for additional SNF days (up to 100 days every benefit period).  If Medicare won’t pay for additional days, neither will the supplemental policy as these policies will usually only cover the portion of approved days that Medicare doesn’t cover. Most patients who use up 100 days of SNF benefits would never go another 60 days in a row without being admitted to the hospital.  They use up their 100 days for a reason. They cannot avoid living at home without avoiding frequent hospital level care.  Clinically, what I see is that most patients who have used up their 100 days in a benefit period will are palliative care candidates or require long term care in a nursing home.
Source: blogspot.com

What Options Do I Have After Exhausting My Medicare Benefits?

Medicare only provides a certain number of hospitalization days for a person’s life time. It also places yearly limits on what a person can receive for certain services. For some people, there is no limit to what a person can receive in a year or a lifetime. When a person exceeds the amount of services that Medicare provides, the options available to him depend on the situation. In some cases, he can use a Medigap plan to extend the services covered. In some cases, he may want to wait until he receives a new benefit period. People who require long time nursing care may be forced onto the Medicaid program.
Source: seniorcorps.org

Medicare Health Care Anniversary for Active Adults Windsong

Maintaining a healthy lifestyle is easier for Windsong homeowners. Each Windsong active retirement community was designed to help Boomers cultivate new friendships and make it enjoyable to stay active, with walkable streets and a private fitness center in the clubhouse, neighbors with similar life-stage experiences, and home designs that maximize accessibility, minimize hassles and provide opportunities to enjoy an active lifestyle without sacrificing style or luxury.
Source: atlantaranchhome.com

A Simple Primer on Medicare Benefits Written for Patients and YOU!

Strategist, Rehabilitation Management, MediServe a Mediware Company; Darlene is a PT with an MBA in Healthcare Management, in her role, as a Rehab Mgmt Strategist/Consultant she brings information to leadership that help guide practice strategy. Her focus is to assist clients nationally in the use of charting data to drive clinical and financial performance in support of decisions for best practices in meeting rehabilitation compliance, outcomes, revenue and efficiency. Since February 2011, Darlene has visited more than 30 IRF locations to assist in guiding C.O.R.E. (Compliance, Outcomes, Revenue, Efficiency/Effectiveness), performance improvement plans. Working in rehab medicine for greater than 30 years, Darlene spent 12 years in executive leadership as a Director of Rehabilitation and Operations. Therapy oversight included three post-acute service lines: acute inpatient rehabilitation (IRF), skilled and outpatient hospital-based services and is LEAN trained in healthcare. At various points in her career, Darlene had oversight of rehabilitation admissions, marketing, quality improvement, dietary & maintenance. Her responsibilities have included compliance toward Federal Regulations and leading CARF and Joint Commission standards of practice. Her experience includes Quality Improvement Chair, Lean Healthcare Trainer Certification and Vice President of the Board of Directors for the Ohio Association of Rehabilitation Facilities (OARF). Darlene lectures and writes blogs on post acute care topics that include federal guidelines, post acute admissions, managing outcomes, documentation, and rehabilitation marketing. www.mediserve.com/blog
Source: mediserve.com

Medicare Part A Benefit Period

Medicare Part A in 2005 has a deductible of $912.  That means the insured is responsible for the first $912 of inpatient hospital expense before Medicare will begin to pay.   The bad news for the insured is that this deductible can occur more than one time during the year.  This is one of the main reasons a medicare supplement is so important.  All medicare supplements, with the exception of Plan A, cover this deductible.
Source: medicaresupplementcenter.com

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August 16, 2013

Tim Scott Asks Feds to Ensure Access to Health Care Supplies for SC Seniors

Posted by:  :  Category: Medicare

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The letter continued, “We are also concerned that general access to local providers will soon be a thing of the past. More than 25 contracts have been won by companies that are 2000 miles away from the bid area for which they were awarded. One company in particular won bids to provide oxygen in all of the South Carolina competitive bid areas, but this company is located in California. Bids on more than 200 contracts have been awarded to companies in states that do not even share a border with South Carolina. Instead of continuing to have access to their local providers, Medicare beneficiaries will have to work with companies that are located an average of 200 miles away from the market that they will be serving after July 1.”
Source: imms.com

Video: Medicare Supplement in South Carolina by 1 800 MEDIGAP®

Richland County South Carolina Medicare Supplement Quotes

Robert Bache aka MedicareBob owns and operates Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: srhealthcaredirect.com

Grant Opportunity to Improve Healthcare for Medicare, Medicaid

The Centers for Medicare & Medicaid Services (CMS) has released a Funding Opportunity Announcement for round two of the Health Care Innovation Awards. Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.
Source: eatsmartmovemoresc.org

South Carolina plans changes for Medicaid

Medicare doesn’t “take care” of the elderly. It pay 80% of the costs of medical care. Each time an elderly person goes into the hospital per every 60 period he/she will pay and $1100.00 deductible (which will probably go up next year). Almost all private health insurances cover hospice but more than likely if you are dying a slow death from a terminal illness you are old enough to have Medicare. In SC the only ppl who get Medicaid are those who have been determined disabled by Social Security AND meet the federal poverty guidelines or Working Poor with young children who again, must meet income guidelines. Its not as easy as you think to just “go on Medicaid” in our state. Criteria in each state is different. To say you don’t care about people less fortunate and disabled getting things cut that they desperately need is not really in the holiday spirit now, is it?
Source: augusta.com

89 Charged with Medicare Fraud After Busts in 8 Cities

If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicare fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid and Medicare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800
Source: stromlawnursinghomeabuse.com

Medicaid Expansion Would Help Working South Carolinians

SCDHHS Director Tony Keck suggests that major portions of the uninsured will be covered under the Health Insurance Marketplace (what we used to call the Exchange). If South Carolina fails to expand Medicaid, businesses with more than 50 employees could face $30-$46 million in potential shared responsibility liabilities according to Jackson-Hewitt Tax Service as employees making between 100 percent and 138 percent of the Federal Poverty Level, but not covered by their employer, enroll through the new Healthcare Marketplace. If South Carolina expanded Medicaid, those employees would be Medicaid eligible and their employers would not be subject to the shared responsibility tax liability of $2,000 to $3,000 per employee who enrolls through the Marketplace.
Source: theruoffgroup.com

Georgia, South Carolina not expanding Medicaid

“For the provisions of the Affordable Care Act related to health insurance coverage, CBO and JCT’s latest estimates are quite similar to the estimates we released when the legislation was being considered in March 2010. The following figure shows CBO and JCT’s projections of the effects of the ACA on the number of people who will be uninsured or will receive insurance coverage through employer-sponsored insurance (ESI), insurance exchanges, or Medicaid or the Children’s Health Insurance Program (CHIP). Although the latest projections extend the original ones by three years (corresponding to the shift in the regular 10-year projection period since the ACA was first being developed), the projections for each given year have changed little, on net, since March 2010.”
Source: augusta.com

Guest Post:The Obama Medicare Agenda: Why Seniors Will Fare Worse

For Medicare Parts B and D, the President’s budget plan would expand “means testing” in the Medicare program for upper-income seniors, resulting over time in a total of 25 percent of all Medicare beneficiaries paying an income-adjusted premium. Under current law, there are four income-adjusted brackets; seniors in these income brackets pay progressively higher premiums, ranging from 35 percent to 80 percent of total Medicare program costs. In his latest budget proposal, President Obama expands the number of brackets from four to nine, requiring seniors to pay from 40 percent to 90 percent of total Medicare premium costs. For the lowest bracket, an individual with an income of $85,000 to $92,333 who is enrolled in Part B and Part D would have a combined premium increase of about $401.76 in 2017, compared to what he would pay under current law. For an individual with an annual income between $178,000 and $196,000, his combined premium increase would be an estimated $1,615 in 2017 (at 85.5 percent of total costs).
Source: southcarolinateapartycoalition.com

Private Medicare Plans Overpayed by Billions

The Government Accountability Office (GAO) has released a report on the results of an audit that looked at funds being distributed to private Medicare beneficiaries compared to public, fee-for-service payments. The GAO suggests the Centers for Medicare and Medicaid Services (CMS) did not accurately calculate payment rates for the two categories, allowing private Medicare Advantage (MA) plans to code for higher payments than traditional Medicare. Estimates are as high as $5.1 billion in overpayments between 2010 and 2012 to MA. GAO is urging CMS to implement better beneficiary questioning techniques to help stop the problem.
Source: schealthcarevoices.org

Ambulance Company Pays $800,000 to Settle Claims of Medicare Fraud

The lawsuit was originally filed by Sandra McKee, a social worker who worked at a dialysis center where Williston’s ambulances dropped off patients. McKee sued under the qui tam provision of the False Claims Act, which allows private parties to sue on behalf of the United States for fraudulent use of government funds.  The government then decides whether to intervene in the lawsuit.
Source: employmentlawgroupblog.com

Health Subcommittee Examines Commonsense Reforms to Medicaid Program, Including State Flexibility to Help Provide for Most Vulnerable Americans

Seema Verma, President of SVC, Inc, testified that the current structure of Medicaid does not guarantee quality care for those who need it most. “Despite growing outlays of public funds, a Medicaid card does not guarantee access or quality of care. In a survey of primary care providers, only 31 percent indicated willingness to accept new Medicaid patients. In 2012, 45 states froze or reduced provider reimbursement rates, Medicaid access issues are tied to under compensation of providers; on average Medicaid payments are 66 percent of Medicare rates and many providers lose money seeing Medicaid patients”, said Verma. “Medicaid beneficiaries struggle to schedule appointments, face longer wait times, and have difficulty obtaining specialty care.”
Source: house.gov

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August 16, 2013

Medicare and Health Insurance, What is Covered, Medicare Supplement

Posted by:  :  Category: Medicare

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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

Video: How do I Apply for Medicare? ClearMedicare Founder Buzz Stone Explains the Supplemental Plans

Medicare Supplement Guaranteed Issue

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Source: medicarechoicesofarizona.com

Medicare Enrollment Frequently Asked Questions (FAQ)

You may register for Medicare Part A and Part B during what’s known as the Initial Enrollment Period (IEP), which varies by individual. Your IEP begins three months before your 65th birthday, and lasts through your birthday month and the three months that follow it. You can apply online at SocialSecurity.gov or by visiting your local Social Security office. If you wish to register over the phone, you may call the Social Security office at 1-800-772-1213. If you worked for a railroad, then you can register over the phone by calling the Railroad Retirement Board at 1-877-772-5772.
Source: planprescriber.com

In States That Don’t Expand Medicaid, Some Of The Uninsured May Still Get Help

But if an individual projects their income up to 10 percent higher than shown in electronically available data such as a prior tax return, there will be no questions asked. If there is more than a 10 percent discrepancy, the exchanges will ask for more information, such as a pay stub. If an applicant is unable to provide such data, the regulations allow the exchanges in 2014 to rely on the individual’s “self-attestation” to determine the subsidy. This applies only when someone overestimates their income, according to a spokeswoman for Health and Human Services.
Source: kaiserhealthnews.org

Medicaid Expansion Through Premium Assistance: Arkansas and Iowa’s Section 1115 Demonstration Waiver Applications Compared

Arkansas Medicaid, Health Care Independence (a/k/a Private Options) § 1115 Waiver, available at https://www.medicaid.state.ar.us/general/comment/demowaivers.aspxu; Iowa Department of Human Services, Iowa Marketplace Choice Plan § 1115 Waiver Application, available at http://www.ime.state.ia.us/iowa-health-and-wellness-plan.html; see also Kaiser Commission on Medicaid and the Uninsured, Medicaid Expansion through Premium Assistance:  Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal (July 2013), available at http://www.kff.org/medicaid/issue-brief/medicaid-expansion-through-premium-assistance-key-issues-for-beneficiaries-in-arkansas-section-1115-demonstration-waiver-proposal/. 
Source: kff.org

Application of Medicare Contribution Tax of 3.8% to Certain U.S. Persons Owning Stock in A Controlled Foreign Corporation or Passive Foreign Investment Company

As mentioned, a U.S. shareholder of a CFC is required to include certain amounts in income, i.e., Subpart F income to the extent of earnings and profits, under Section 951(a). The Preamble to the Section 1411 proposed regulations states that constructive or pass through income includible under Section 951 will generally not be treated as dividends in computing NII as dividend income unless expressly provided for in the Code. Still NII treatment will result to the extent the Subpart F income is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii)(trading trading in financial instruments or commodities) and Prop. Treas. Reg. § 1.1411-4(a)(1)(ii)). As to PFICs, a U.S. person is required to income in income amounts described under Section 193 if the taxpayer makes a QEF election under Section 1295.. Section 1293 inclusions also are not treated as dividends unless expressly provided for in the Code, and, therefore, also are not taken into account for purposes of calculating net investment income (unless the amount is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii) and Prop. Treas. Reg. §1.1411-4(a)(1)(ii)).  This difference in timing for reporting income for chapter 1 (regular income tax) and chapter 2A (Section 1411), as well as other overlapping provisions, will require a taxpayer to compute separate stock basis for chapter 1 and chapter 2A, subject to making an election under Prop. Reg. §1.1411-10(g) which seems to only be available after 2013 although the Preamble to the regulations when read with the proposed regulations is not entirely clear on this point, i.e., whether such election can be made for a taxable year beginning in 2013.
Source: theft-protection.info

How observation admissions affect Medicare patients

My 86 year old dad with hypertension, hyperlipidemia, barrets esophagus and moderate cognitive dysfunction called 911 with chest pain at 2:45 AM. The paramedics checked him out and advised a visit to the ER. My wheelchair bound 83 year old mother was in no position to do anything but comply. He was taken to Hollywood Memorial in Hollywood, Florida where the ER staff did not call his personal primary care physician of fifteen years but made a mistake and called the hospitalist. He was kept in the ER for seventeen hours as an outpatient observation. When an MI was ruled out by EKG and enzymes he was moved to the floor. Twelve hours later after an ultrasound of the gall bladder showed a thickened wall and a big stone ( I am told he had normal liver function tests and a normal WBC) he was taken to the OR for a lap cholecystectomy. The next day his surgeon came in after noon and told him he was ready for discharge. He had not eaten anything other than clear liquids, he had not ambulated, he had not moved his bowels. When my mother objected, his PCP said unless you take him home now, Medicare will not pay for the stay and you will need to pay for the care out of your pocket. He was discharged with no home health services or evaluation performed. The discharge process , started after 5PM resulted in him not arriving home ( a ten minute drive) until almost 11 PM. A wound care nurse came in the next afternoon. Her supervisor called me to say she thought he was discharged prematurely and should have gone to a rehab facility until he demonstrated he could ambulate and get to the bathroom. Medicare law apparently allows you to go into an SNF after a three day hospitalization for up to 30 days after discharge if you have the 3 day inpatient admission. When we reviewed the matter his first 17 hours were treated as an observation. That plus the abrupt discharge left him hours short of the required three days. When I called his PCP she blamed the hospital and coding people. When i spoke to the hospital social worker , coders and medical director they blamed the PCP who had the opportunity to make the first 17 hours an admission and had the criteria but did not. While I blame the overworked PCP and the hospital system the fault is ultimately mine for living a bit too far away to spend enough time at the hospital to detect the shennanigans . I usually request permission to review the chart but this time out of respect for his doctor took a background role. I was wrong. Had my dad been a patient in my practice I would have fought tooth and nail to get him the benefits he earned. I do not mind being considered a tough SOB by hospital administration when I am an advocate for my patient especially since they meet criteria. In my thirty plus years of internal medical practice I find patients bounce back for readmission when they do not follow instructions. Non compliance is usually the top ten reasons. The diagnosis may be listed as CHF or arrythmia or urine infection and sepsis but the real explanation is that someone didnt follow instructions. If hospitals are going to be penalized for these situations we can only expect more predatory behavior , abrupt discharges and manipulation of the system as the baby boomers age. As their physicians become employed shift workers of the hospital or Accountable Care Organization with no longitudinal relationship with the elderly patients, the likelihood of this situation getting worse will increase. There will be no patient advocates unfortunately !
Source: kevinmd.com

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August 16, 2013

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

Posted by:  :  Category: Medicare

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

Video: Determination of Medicare Coverage of Test and Treatments – Day 1 (CFSAC Spring 2013)

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

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

Dupuytren › medicare coverage

As my father would say, this is all grist for the mill. The more info the better. If I don’t know more about my own disabilities than my doctor than I am not showing enough interest, and deserve what I get. The one thing that I am sure of is that I am going to get the radiation therapy. Cost aside, this seems to be the only therapy that can actually stop the progression of dup, and has a pretty high success rate. Apparently it is also necessary to do it before the contractures for the best possible outcome. I am not a fan of radiation, but the statistics indicate that there is a very low possibility of ending up with cancer from it. And I can already feel my little finger losing its flexibility. The only variable seems to be the expenses involved. If it did not require two sessions separated by 6 to 8 weeks, I would have considered taking a nice vacation to Hamburg. On the other hand, if medicare and my supplemental insurance will cover it, then I will try to have it done in Palo Alto (I can go to Germany later with the money I save–lol). If medicare will not cover it, I may need to compare prices. If Palo Alto is $25,000 and Portland is $9,000, then I think a nice trip to Portland would be cool. Either way I would have to rent a place for the 5 days, and either fly to Portland from Fresno, or rent a car to drive to Palo Alto (my electric car won’t go that far). I really feel much better about this whole thing, even with all of the variables. All of you are the reason. Any further advise that you can provide will be most appreciated. Any medicare info, any doctor info, any personal experiences that could help me through this would be great. thank you, thank you Your dup friend Bill Rovin wlrovin@aol.com
Source: dupuytren-online.info

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

CMS Revises Medicare National Coverage Determination Process, Eases Path to Discontinue Outdated Coverage Policies : Health Industry Washington Watch

Most notably, the notice outlines a new, expedited administrative process to remove certain NCDs that CMS determines to be no longer needed, thereby enabling local Medicare contractors to determine Medicare coverage. In explaining the impetus for its proposal, CMS notes that “[w]e are aware that clinical science and technology evolve and that items and services that were once considered state-of the-art or cutting edge may be replaced by more beneficial technologies or clinical paradigms.” CMS therefore intends to periodically review the inventory of NCDs that have not been reviewed for more than 10 years to evaluate whether there is a continued need for national policies. CMS believes that local contractor discretion is more appropriate in these cases because “the future utilization for items and services within these policies will be limited.” Under the new, streamlined process, rather than use the formal NCD reconsideration process (which generally takes 9 to 12 months), CMS will periodically publish on its website a list of NCDs proposed for removal along with the agency’s rationale. CMS will solicit public comment for 30 calendar days, and then either: (1) follow the proposal to remove the NCD; (2) retain the policy as an NCD; or (3) formally reconsider the NCD and post a tracking sheet to that effect on the CMS coverage website. The final list will be effective upon posting it to the website.
Source: healthindustrywashingtonwatch.com

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

Researchers from Finland, the UK, and the US report on findings from a genome-wide association study of hereditary glaucoma in dogs. The team focused on the Dandie Dinmont Terrier, a breed prone to a form of progressive, adult-onset glaucoma that resembles primary closed-angle glaucoma in humans. By genotyping 23 affected and 23 unaffected dogs using Illumina’s Canine SNP20 chip, authors of the study picked up a chromosome 8 locus with apparent ties to glaucoma risk in the terrier. And fine-mapping experiments in a larger set of cases and controls from the same breed helped the study’s authors narrow in on the most significantly associated SNPs at that locus, which corresponds to a region of the human chromosome 14 housing genes previously implicated in other forms of glaucoma.
Source: genomeweb.com

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

With Vectra DA, physicians have an absolute metric that doesn’t depend on subjective inputs that can vary significantly and be difficult to interpret. By providing a specific and precise way to measure RA disease activity that complements a clinician’s expert assessment, Vectra DA helps facilitate more efficient management of patients. In addition to the advantages this provides in the context of an individual patient, Crescendo Bioscience developed VectraView – an online disease analytics tool that allows rheumatologists to order and manage Vectra DA tests, as well as evaluate the test results of all of their RA patients as a group. Furthermore, the Company has developed a patient support tool, a free iPhone app called MyRA
Source: crescendobio.com

Healthcare Reform in 2014

Members of Christian healthcare sharing programs such as Medi-Share are exempt from the individual mandate of the act. Native Americans, illegal immigrants, inmates, and people claiming religious opposition will not be required to obtain individual or family healthcare under the PPACA, nor will they face financial penalties from the IRS for failing to obtain coverage.  . In addition, people who have low incomes and are not required to file federal tax returns or for whom the cost of health insurance would be more than 8% of their income, would also be exempt from the PPACA requirements.  Furthermore, if you have or are eligible for Medicare or Medicaid, you do not have to obtain additional coverage under the Act.
Source: medi-share.org

How The Other Washington May Hold The Key To The Medicare Cost Crisis

Yet when it comes to setting Medicare coverage policy, relatively few decisions are actually made in Washington, D.C. The Centers for Medicare and Medicaid Services administers the program, but the nuts-and-bolts processes of running the program, including making coverage decisions and paying claims, are performed mostly by private insurance companies that contract with the federal government. Each year, Medicare does institute a dozen or more “national coverage decisions,” often on high-profile or costly procedures. Other procedures are subject to so-called local coverage determinations by the regional insurance contract adminstrators. The result is a fragmented program in which a procedure Medicare pays for in New York is not necessarily covered in Kansas.
Source: kaiserhealthnews.org

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