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

Posted by:  :  Category: Medicare

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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

Video: Phone Number Medicare Providers Mobility Scooter Store Spinal Cord Injury Around Round Rock

Feds ban some Medicare providers in crackdown

The moratorium, which was first reported by The Associated Press, will also extend to Children’s Health Insurance Program providers in the same areas, agency administrator Marilyn Tavenner said in a statement. It’s unclear how many providers will be shut out of the programs. There were 662 home health agencies in Miami-Dade in 2012 and the ratio of home health agencies to Medicare beneficiaries was 1,960 percent greater in Miami Dade County than other counties, according to figures from federal health officials. South Florida, long known as ground-zero for Medicare fraud, has also had several high profile prosecutions involving that industry. In February, the owners and operators of two Miami home health agencies were sentenced for their participation in a $48 million Medicare fraud scheme. The number of home health providers in Cook County, Ill., increased from 301 to 509 between 2008 and 2012. There were 275 ambulance suppliers in Harris County, Texas, in 2012. The ratio of providers to patients in both regions was also several hundred times greater than in other counties, federal health officials said. Top Senate Republicans have criticized the agency for not using the powerful moratoriums sooner as a tool to combat an estimated $60 billion a year in Medicare fraud. Senators Chuck Grassley, who is the ranking Republican on the Judiciary Committee, and Orrin Hatch, who is the ranking Republican on the Finance Committee, sent a letter to federal health officials in 2011 urging them to use moratoriums. “While it’s certainly better late than never, it’s unfortunate that it took CMS three years to use the tools it’s had to protect seniors,” Grassley said in a statement Friday, adding he hoped “to see more action like this.” Officials for HHS’ Office of the Inspector General lobbied hard to ensure moratorium power was included under the Patient Protection and Affordable Care Act as the Obama administration focuses on cleaning up fraud on the front end by preventing crooks from getting into the program in the first place. In the past, federal health officials tried to stall new provider applications from being processed, hoping to slow the number flocking to high-fraud sectors. But when providers inevitably complained, the agency had to process their paperwork. The federal agency can also revoke the IDs of suspicious providers, but those are temporary and many companies are able to reenroll later or enroll under a different name. Federal health officials have been reluctant to use one of its most powerful new tools, worrying moratoriums may harm legitimate providers and hamper patients’ access to care. Tavenner said in the statement that would not happen, but the agency didn’t elaborate. Agency officials said they intend to consider other moratoriums in different industries in other cities going forward. The ability to target certain industries and cities is especially helpful as Medicare fraud has morphed into complex schemes over the years, moving from medical equipment and HIV infusion fraud to ambulance scams, as crooks try to stay one step ahead of authorities. Fraudsters have also spread out across the country, bringing their scams to new cities once authorities catch onto them. The scams have also grown more sophisticated, using recruiters who are paid kickbacks for finding patients, while doctors, nurses and company owners coordinate to appear to deliver medical services that they are not. The moratoriums come as budget cuts are forcing federal health officials to retract its watchdog arm as it launches its largest healthcare expansion since the Medicare program. Health and Human Services inspector general officials said they are in the process of cutting 20% of its staff, from 1,800 at its peak to 1,400, and cancelling several high-profile projects, including an audit that would have investigated technology security in the federal and state health exchanges launching in October. The project was slated to examine issues including whether patient information was secure from hackers on the online marketplace, where individuals and small businesses can shop for health insurance. The agency also said it was cancelling an audit into the number of antipsychotic drugs prescribed to nursing home patients and another project investigating how many fraudulent Medicare providers get back into the program after their license is revoked.
Source: modernhealthcare.com

Dealing with the shortage of primary care providers

The Institute of Medicine, part of the National Academy of Sciences, is studying the issue of GME and how best to align financing with the needs of the public for the health care workforce. The Institute’s report is due in 2014. Among the issues that will be considered will be the appropriate level of funding for teaching hospitals and proportion of funding for teaching hospitals versus community-based clinics and health centers. Recruitment of physicians, particularly for primary care, also could be increased by more use of medical school scholarships and loan forgiveness programs.
Source: practicelink.com

Update to Disproportionate Share Instructions in the 2014 IPPS Final Rule

CMS has calculated an estimated per-discharge (or per-claim) amount for each hospital eligible to receive interim uncompensated care payments and will pay that estimated amount on a per-discharge basis by adding it to the payment otherwise made on that claim. The estimated per-discharge amount is based on the amount of the uncompensated care payment CMS has calculated for the hospital for a fiscal year divided by the average number of discharges, or claims, in the most recently available three fiscal years of the Medicare claims data set. For FY 2014 payments, CMS will use the average number of claims from the most recent three years of MedPAR claims data:  FY 2010, FY 2011 and FY 2012. The total amounts paid on a per-discharge basis during the federal fiscal year will be reconciled with the amount of the uncompensated care payment calculated for the hospital for the fiscal year at cost report settlement.
Source: healthcarereforminsights.com

Medicare This Week: National Provider Call on Registration and Attestation, New CMS Video Education on Youtube, Updates from the Medical Learning Network

From the MLN: “Negative Pressure Wound Therapy Interpretive Guidelines” MLN Matters® Article Released – MLN Matters® Special Edition Article #SE1222, “Negative Pressure Wound Therapy Interpretive Guidelines” has been released and is now available in downloadable format. This article is designed to provide education on CMS-approved guidelines that accrediting organizations can use to accredit suppliers that provide Negative Pressure Wound Therapy (NPWT) equipment to Medicare beneficiaries.  It includes a list of relevant local coverage determinations and standards to help DMEPOS suppliers comply with standards and guidelines for NPWT equipment.
Source: managemypractice.com

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

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

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

Posted by:  :  Category: Medicare

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

Video: How to Save Medicare $30 billion: www.UpgradeThe Card.org

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

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

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

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

Today in labor history: Medicare and Medicaid established

Because protecting and improving Medicare is critical to health care cost containment, Republican proposals to pare back Medicare actually would increase overall health care costs. For example, the Republican budget proposal for FY 2012 would replace Medicare with vouchers to purchase private health coverage. According to the Congressional Budget Office, this proposal would result in total health care spending for an average 65-year-old that is nearly 40 percent higher than under the current Medicare program. Out-of-pocket costs for a typical senior would almost double. The result of this proposal would be to simply shift costs onto seniors, not to control costs.
Source: peoplesworld.org

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

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

Where the Medicare Dollars Go

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Railroad Medicare is Part B Medicare for retirees

Posted by:  :  Category: Medicare

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

Video: Attained age vs Community rated Medigap policies

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

UCSF HR/Benefits Open Enrollment 2010: Oops

You should know, there is inaccurate information about Medicare on page 4 of the hard copy of your Open Enrollment Booklet. The information indicates that employees/and or family members that become Medicare eligible must enroll in Medicare and in a Medicare coordinated plan. This is absolutely wrong! If you continue working at UC past age 65, you are not required to sign up for Medicare Part B. In fact, you may delay enrollment, without penalty and the University does not even provide a Medicare coordinated plan option for employees that have not yet retired. For more information, see the Medicare Factsheet [PDF] and/or contact Social Security at 800-772-1213. A corrected version of the Open Enrollment booklet is available online.
Source: blogspot.com

Medicare This Week: National Provider Call on Registration and Attestation, New CMS Video Education on Youtube, Updates from the Medical Learning Network

From the MLN: “Negative Pressure Wound Therapy Interpretive Guidelines” MLN Matters® Article Released – MLN Matters® Special Edition Article #SE1222, “Negative Pressure Wound Therapy Interpretive Guidelines” has been released and is now available in downloadable format. This article is designed to provide education on CMS-approved guidelines that accrediting organizations can use to accredit suppliers that provide Negative Pressure Wound Therapy (NPWT) equipment to Medicare beneficiaries.  It includes a list of relevant local coverage determinations and standards to help DMEPOS suppliers comply with standards and guidelines for NPWT equipment.
Source: managemypractice.com

Download the Medicare and You 2010 Medicare Handbook

The federal Department of Health and Human Services has released the 2010 Medicare and You consumer handbook. This is the official government benefit description manual issued to Medicare members. The handbook contains information on the following:
Source: elderguru.com

Centers for Medicare and Medicaid Release Mammography Booklet

In early March, the Centers for Medicare and Medicaid released the “Screening and Diagnostic Mammography” booklet in both a downloadable and hard copy format. This booklet is designed to provide education on early diagnosis and treatment of breast cancer. It includes information on screening mammography, diagnostic mammography, as well as other provider and beneficiary resources.
Source: ons.org

Board on Aging publishes Health Care Choices booklet for seniors

The primary purpose of the governor-appointed Minnesota Board on Aging is to ensure that older Minnesotans and their families are effectively served by state and local policies and programs in order to age well and live well. Partnering with area agencies on aging and others, the MBA administers and oversees the use of the Older Americans Act funds as well as state funds to support older Minnesotans. In addition, the MBA provides objective information and data to the Minnesota Legislature, the governor and state agencies to shape policies that reflect the needs and interests of older Minnesotans.
Source: echopress.com

MLN updates education product, info series

MLN Guided Pathways (Basic, A, and B) Provider-Specific Resource Booklets (Revised) — The revised MLN Guided Pathways curriculum is designed to allow learners to easily identify and select resources on topics of interest. The curriculum begins with basic knowledge for all providers and then branches from information for either those enrolling on the 855B, I, and S forms or on the 855A form (or Internet-based PECOS equivalents) to a provider-specific resource booklet. The provider-specific booklet provides various specialties of health care professionals, (physicians, chiropractors, optometrists, podiatrists), nurses (APN, RNCNS, NP, Midwife) physician assistants, social workers, psychologists, therapists (OT, PT, SLP), dietitians, nutritionists, suppliers (ambulance, ASC, DMEPOS, FQHC, RHC, labs, mammography, radiation therapy, portable x-ray), and providers (CMHC, CORF, ESRD, HHA, hospice, OPT, pathology and SNF) with resources specific to their specialty including Internet-Only Manuals (IOMs), Medicare Learning Network publications, CMS web pages, and more.
Source: newsfromaoa.org

Wessays ™: 770 The Medicare Booklet

Guess they need the money to print up those pretty brochures. One “chapter” is called “We’re Always Right Here, Close at Hand.” So let’s make a phone call. Three minutes of introductory blahblah on cell phone prime time, and then someone answers the phone, but can’t answer the question which was “how much are the rates going to rise NEXT year.” “We’ll be sending out notices in the next week or so, sir. But I don’t have the information now.” Hell you don’t. You just don’t want to say because you don’t want your customers calling around to find a better deal. Are you going to call back to answer the question once you admit to having the information? Hold your breath.
Source: blogspot.com

Raiding Medicare: How seniors will pay for Obamacare

Other hospitals will be forced to operate in an environment of scarcity, with as many as 40 percent in the red, according to Foster. That will mean fewer nurses on the floor, fewer cleaners, and longer waits for high-tech diagnostic tests. It will affect all patients. Obamacare’s defenders say that cutting Medicare payments to hospitals will knock out waste and excessive profits. Untrue. Medicare already pays hospitals less than the actual cost of caring for a senior, on average 91 cents for every dollar of care. No profit there. Pushing down the reimbursement rate further, as the Obama health law does, will force hospitals to spread nurses thinner. When Medicare reduced payment rates to hospitals as part of the Balanced Budget Act of 1997, hospitals incurring the largest cuts laid off nurses. Eventually patients at these hospitals had a 6 to 8 percent worse chance of surviving a heart attack and going home, according to a National Bureau of Economic Research report.
Source: dailycaller.com

U.S. Bans New Home Health, Ambulance Providers In Three High

Posted by:  :  Category: Medicare

Fiscal Times: Abuse And Neglect In Assisted Living Facilities You’ve seen the sales pitches about America’s assisted living facilities. Seniors can flourish in bright, cheery alternatives to nursing homes and live out their golden years securely, monitored by medical professionals who tend to their every need. The business of assisted living paints a depressingly different picture, according to a provocative new documentary from PBS Frontline airing this Tuesday night, accompanied by a series from ProPublica that is being published this week. Nearly 750,000 American seniors live in assisted living facilities today — but instead of being cared for, many are abused and neglected, according to a year-long investigation (Mackey, 7/29).
Source: kaiserhealthnews.org

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

CMS Proposes To Further Tighten Medicare Provider Enrollment Rules

Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 
Source: wordpress.com

CMS Announces Medicare Providers Must Begin to Revalidate Enrollment By March 2013

In the continued effort to reduce fraud, waste, and abuse, CMS implemented new screening criteria to the Medicare provider/supplier enrollment process beginning in March 2011.  Newly-enrolling and revalidating providers and suppliers are placed in one of three screening categories – limited, moderate, or high – each representing the level of risk to the Medicare program for the particular category of provider/supplier, and determining the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application. More information on the screening categories is here.
Source: managemypractice.com

Department of Health Services Submits BadgerCare Plus Waiver to Centers for Medicare and Medicaid Services

In addition, the type of waiver that the Department is submitting allows states the flexibility to customize their Medicaid and Children’s Health Insurance Program (CHIP) – called BadgerCare Plus in Wisconsin—programs to meet the needs of their citizens, as long as it is at no additional cost to taxpayers. Through this waiver, Wisconsin seeks to provide full Medicaid benefits through the Standard Plan, including enhanced mental health benefits and preventive benefits, to all adults in poverty who are enrolled in Medicaid and BadgerCare Plus. It is anticipated that offering the same benefits to all adults in poverty will lead to savings for Wisconsin taxpayers because helping individuals get access to these enhanced benefits in the primary care setting will help avoid costly and unnecessary emergency room and in-patient hospital stays.
Source: wisconsin.gov

AHCA: CMS Announces Temporary Provider Enrollment Moratorium

The Centers for Medicare & Medicaid Services have announced a temporary moratorium on the enrollment of new home health provider enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in fraud “hot spot” areas of the country. The goal of the temporary moratorium is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and CMS is exercising this authority for the first time.
Source: hcafnews.com

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

Senators Praise Home Health Moratorium on Medicare Providers

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

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

All providers and suppliers who enrolled in Medicare prior to March 25, 2011 will be required to revalidate their enrollment under the new risk screening criteria required by section 6401a of the Affordable Care Act (ACA).  Those who have revalidated or enrolled since then have already been subjected to the screening.  The MAC will send notice to individual providers and suppliers, between today and March 2013, to being the revalidation process.  Providers and suppliers are required to initiate the revalidation process as soon as they receive notice from their MAC, and must complete the process within 60 days of that notice. 
Source: hallrender.com

Underuse of Hospice Care by Medicaid

Posted by:  :  Category: Medicare

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Patients and Methods Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results–Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006. We evaluated hospice use, timing of enrollment, and location of death (inpatient hospice; long-term care facility or skilled nursing facility; acute care facility; home with hospice; or home without hospice). We used multiple logistic regressions to evaluate clinical and sociodemographic factors associated with hospice use.
Source: ascopubs.org

Video: New York: Medicare Fraud Summit Consumer Panel

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

HAPPY 48TH BIRTHDAY MEDICARE : Single Payer New York

Yet, many in Congress want to privatize Medicare (along with Social Security and Medicaid), to benefit the for-profit health insurance industry at the expense of millions of Americans. Just say NO!    Extending Medicare for all would save more than enough to eliminate all cost sharing such as copays and deductibles, guarantee comprehensive coverage for all, and be there for future generations.
Source: singlepayernewyork.org

Medicare and Medicaid in New York: Understanding the Differences

The Department of Human Services defines Medicare as an insurance program. This is part of the taxes you’ve seen withdrawn from your salary for most of your life. Medical bills are typically covered from this program and it serves those who are 65 or older. Their income plays no role in whether or not they qualify; however, there are still those instances when co-payments are required and generally, there are deductibles. It’s a seamless program from one state to another since it’s overseen by the federal government, specifically, the Centers for Medicare & Medicaid Services.
Source: kobricklaw.com

A New IOM Report Reveals Why Medicare Costs So Much (Hint

“The 2,000-doctor hospital was struggling in March, 2003, when Dr. Kenneth L. Davis took over as chief executive. During the previous six months, Sinai had lost $50 million, partly as the result of tougher caps on Medicare reimbursement rates.  . . . While trimming costs, Davis also decided to build up practices in high-margin specialties. ‘Interventional cardiology was one of myriad areas where we were eager to facilitate growth,’ Davis explains. Dr. Samin Sharma, Mt. Sinai’s “King of Stents,” ran a cath lab which was central to this campaign, performing procedures that typically brought in as much as $20,000 a piece for the hospital.
Source: healthbeatblog.com

Brookhaven NY Auto, Business Insurance and Medicare Supplement Insurance

Commercial insurance means offering the right products for markets of every size. Brisotti & Silkworth Insurance can provide what you need when you need it. Whether you have basic commercial insurance needs or more complex and difficult exposures, our experienced agents will work with you to help you provide your customers with a comprehensive insurance program. Brisotti & Silkworth Insurance (BSI) sells and services many lines of commercial insurance throughout New York. Like auto insurance protects you from the risks of the road, commercial insurance protects you and your business from the risks you encounter every day.  If you own a business, you want to make sure it is always protected. More than likely, you have invested a large sum of money into your business to get it started. Every day, you will encounter risks that have the potential to bring down your business, and potentially your personal finances as well. In order to protect your business and personal finances, business insurance is necessary. Don’t do business without it.
Source: bsiins.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

NY Times Prints Apples vs. Oranges Study on Medicare Costs and Income

The problems with the latest study are identical with those in the comparable “study” issued by the Social Security Administration through the office of Sen. Marco Rubio (R-Fla.). That document showed that if you take a snapshot of the situation you will find that immigrants pay more into the Social Security Trust Fund than they take out, as discussed in this CIS report. The SSA’s tabulations did not touch on the life-long balance of Social Security costs of natives and immigrants, just the short-term balances, which are heavily influenced by the relative youth of the adult migrants.
Source: cis.org

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

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

NY wants to use housing to cut Medicaid costs

Moving high-risk low-income patients into supportive housing in order to cut healthcare costs has been a practice that has stretched back several years. In Sacramento, hospitals have collaborated to obtain housing for patients that regularly frequent their emergency rooms. Similar programs have been adopted in Oregon and Southern California.
Source: fiercehealthfinance.com

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

Posted by:  :  Category: Medicare

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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: Rep. Gingrey Discusses Medicare Reimbursement Rates

Medicare Payment to ASCs: Big Trends & Impact Factors

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

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

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

CMS Announces New Medicare Reimbursement Rates for 2014

The proposed rule would increase IPPS operating rates by 0.8 percent after accounting for inflation and other adjustments required by the law.  This proposed increase also reflects a proposed temporary reduction of 0.8 percent to implement the American Taxpayer Relief Act’s requirement to recoup overpayments from prior years as a result of a new patient classification system that better recognizes patient severity of illness.  CMS is also proposing an additional 0.2 percent reduction to offset projected spending increases associated with proposals regarding admission and medical review criteria for inpatient services.  CMS projects that LTCH PPS payments would increase by 1.1 percent, or approximately $62 million, in FY 2014.
Source: insidepatientfinance.com

Medicare Doctors: More are Opting Out of the Medicare Program

I am a Medicare participant and have watched over the years Medicare and medigap premiums rising, yet the government is reluctant to pay the cost of medical expenses for seniors. If many or most doctors opt out of these plans what are seniors on a tight fixed budget like me to do? Our government seems so hellbent to create government sponsored medical programs but are totally forgetting folks who worked all their life and who now live on a fixed income and are not able to pay non-generic costs for medication or pay as you go medical plans. Maybe they will give all retirees a black pill and get rid of all of us. I would not put that past this government of our now. Shades of Soylent Green!!
Source: planprescriber.com

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

House Panel Releases Draft Bill To Repeal Medicare’s Payment System For Doctors

MedPage Today: GOP: Repeal SGR And Grant Annual Pay Raises For 5 Years House lawmakers late Thursday released the final draft of a bill that repeals Medicare’s sustainable growth rate (SGR) payment formula and replaces it with a system that incentivizes quality and efficiency starting in 2019. The bipartisan measure provides 5 years of stable Medicare payments starting next year, with reimbursements growing 0.5 percent for each year between then and 2018, according to the 70-page, yet-to-be-named bill. After those 5 years, physicians would be subject to having reimbursements based on performance on quality measures, or may opt out of that requirement if they practice in certain alternative payment models (Pittman, 7/18).
Source: kaiserhealthnews.org

Proposed Payment Changes for Medicare Home Health Agencies

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

Aetna to cut pathology reimbursement to 45

In 2011, Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume and/or high-expenditure lab tests. Medicare could have saved $910 million, or 38 percent, on these lab tests if it had paid providers at the lowest established rate in each geographic area. State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates, although most pay less. However, unlike Medicare, FEHB programs incorporate factors such as competitor information, changes in technology used in performing lab tests, and provider requests in their payment rates. Some State Medicaid programs and FEHB plans required copayments for lab tests, which, in effect, lowered the costs of lab tests for the insurer.
Source: pathologyblawg.com

Surviving at Medicare Rates: An Exercise for Physicians to Consider

Step 5: Manual Option You will need to generate a charges and collections report by CPT code and find the top 25 codes to30 codes that likely generate 80 percent to 90 percent of your revenue and then manually multiple frequency by RVU weight and then use that total to divide into your cost. This will slightly overstate your cost but you’ll be close. Future payment models may provide for incentive payments that will get you above Medicare rates but, typically, these will be paid on a quarterly or annual basis so you will need to fund day-to-day operations from the basic rate. If you find that expenses exceed this basic rate, consider options for reducing operating costs (or your income) to bring the numbers in line. You might want to read an earlier blog about cost reductions to get some ideas.
Source: physicianspractice.com

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August 19, 2013

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

Posted by:  :  Category: Medicare

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Counseling is free, objective and confidential and encompasses assistance with questions about Medicare, Medigap, Medicare Advantage, Medicare Part D, Long-Term Care Insurance and Dual-Eligibility. Sessions are conducted by telephone so that travel is not necessary.       
Source: mhanj.org

Video: Medicare Agent Training

The CareGiver Partnership: The Goose That Laid The Golden Medicare Egg is Dead

When that call to action is supported with just under $200 million a year in continuous bombardment television advertising (and radio, direct mail), it makes people want to get the free stuff. Lately, you may have seen non-stop ads from a company called SafeLink which is giving away free phones and minutes to those on food stamps and Medicaid.  The free phones and minutes are funded by The Universal Administrative Company (USAC) which takes money we pay to phone companies in our bills and they fund the free phones with it (and other programs).  When you peel back the layers you discover that USAC is the administrator and the fund manager referred to as USF of Universal Service Fund.  Digging even deeper, you find this leads back to Washington  and the FCC which actually has oversight for USAC.  SafeLink is a company taking advantage of this government program that we are all paying for and creating the expectation for a free cell phone and minutes.
Source: caregiverpartnership.com

Free counseling offered on Thursday for seniors on Medicare, Medicaid and Social Security

The Dallas Area Agency on Aging will be offering free counseling on Thursday for seniors who have questions about Medicare, Medicaid and Social Security. To make an appointment with a benefits counselor, call Carolyn Toliver at 214-954-4204.
Source: dallasnews.com

Telephone Scam Aimed at Medicare Beneficiaries

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

Solving the Problems of Medicare through Entrepreneurship

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

CPA discusses 2013 Medicare 3.8% Surtax Planning for IRS Tax Form 1041

Gary Bode, CPA is a Master’s Degreed, nation wide accountant offering tax and business services. Member of AICPA and NCACPA. Our virtual office provides excellent service to long distance and international clients. Call (910) 399-2705 for a free phone consult.
Source: cpawilmingtonnc.org

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August 19, 2013

ADA Offers Free Course on Becoming a Medicaid Provider

Posted by:  :  Category: Medicare

Despite misconceptions and fears associated with being a Medicaid provider, treating this population can be rewarding and contribute positively to your bottom line.  Medicaid providers will share three effective practice models and opportunities/challenges regarding compliance, fraud, advocacy and more. After this course, you will be able to:
Source: ksdental.org

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Many Kids on Medicaid Don’t See a Dentist

Even though this number has improved by 16% between 2002 and 2007, there are still many children who cannot access care due to the loss of school-based dental education programs, state budget cuts, low reimbursement rates that prevent providers from accepting Medicaid patients, and the overall lack of Medicaid dollars going toward dental care. Although the Centers for Medicare and Medicaid Services (CMS) has put goals in place for preventive services, the only long-lasting solution will be an increased investment in dental care.
Source: pilcop.org

WellCare of Kentucky’s oral health initiatives yield positive results for Medicaid members

WellCare Health Plans, Inc. announced positive results from initiatives aimed at improving the oral health of its Medicaid members in Kentucky.   Since November 2011, when the company began serving the state’s Medicaid population, WellCare of Kentucky’s oral health initiatives increased the number of WellCare dental providers by 114 percent, expanded the network into 12 additional counties and grew the number of WellCare provider locations by 67 percent. WellCare also added specialists for periodontics, and oral and maxillofacial pathology to its dental network.   In 2012, to increase preventive appointments, the company identified and contacted members who were due for an annual appointment and provided an incentive to encourage visits. As a result, more than 1,500 WellCare Medicaid members, who otherwise would not have had a preventive dental visit, took advantage of this benefit.   The Centers for Disease Control and Prevention ranks Kentucky 45th among the states for the percentage of adults over age 18 who made a dental visit within the past year, and according to the Centers for Medicare and Medicaid Services, only 43 percent of children in Kentucky received an annual preventive care visit in the past year.   “Oral health is a key component of overall physical health,” said Kelly Munson, chief operating officer of WellCare of Kentucky. “In Kentucky, WellCare is focused on expanding its network of dental providers, educating about the importance of oral health and encouraging annual preventive dental screenings to help our members lead better, healthier lives.”   The member outreach and incentives program continues in 2013. WellCare of Kentucky Medicaid members can call 1-877-389-9457 and 1-877-247-6272 for more information about their dental benefits.   From WellCare
Source: kyforward.com

Improving oral health for children in Medicaid, NC Health Choice

Tooth decay is the most common chronic disease among children ages 5 to 19, affecting approximately 1 in 5 children. In North Carolina, 14 percent of children in kindergarten (ages 5-6) have untreated dental decay in at least one primary tooth. A number of factors put some children at greater risk of developing dental cavities, particularly low socioeconomic status and minority race/ethnicity. With proper dental care and dietary choices, dental cavities and decay could almost be eliminated among children. While North Carolina has made tremendous improvements in dental service utilization by children enrolled in Medicaid and NC Health Choice over the past decade, there is still room for improvement. Only 45 percent of children enrolled in Medicaid and 49 percent of the children enrolled in NC Health Choice received at least one preventive service from a dentist in FFY 2012.
Source: ncchild.org

Vision Insurance: Medicare Dental and Vision What

Community or Government Common and Vision Care – I’ve seen ads for dental laser centers, ad even mobile dentistry vans, at local arrest centers. Many church or community sponsored centers really should have information on reduced include clinics for seniors, handicapped people, or others with low income. The federal government, suggest, or county may and then for run reduced fee clinics some areas. Your local health insurance and human resources offices absolutely need information. There is help meant for older people, but it’s going to take some digging to dig it.
Source: blogspot.com

Medicare Dental question raised again : Bite Magazine

Despite much discussion about dental care being brought under Medicare over the last decade, the suggestion remains controversial. The Australian Dental Association has consistently voiced opposition to the change. The Australian Greens political party has promoted Medicare coverage for dental care as a key part of its health platform, and Greens health spokesperson Senator Richard Di Natale re-affirmed that goal when celebrating their agreement on dental reform last year. However, at the time Health Minister Tanya Plibersek was careful not to suggest that a Medicare dental scheme was the next step.
Source: com.au

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August 19, 2013

Extending Social Security and Medicare Eligibility Ages

Posted by:  :  Category: Medicare

In light of the increase in life expectancy after age 65 and the decline in physically demanding jobs, it would be reasonable for the eligibility age for social security to rise to 68 or 70. The average age of retirement from the labor force for Japanese males is already only a little below 70, which shows that much higher retirement ages is feasible. Persons who are physically or mentally incapable of working would then opt for disability status. This is a rapidly growing category in most developed countries, despite the increase in physical and mental health of older persons, because of a weakening of qualifying standards. With more flexible labor markets for the elderly, such as reducing the fear of companies that they will be sued for discrimination against older workers, older men and women could retire from more demanding jobs, and take jobs that are less taxing. This is what happens to older men in Japan.
Source: becker-posner-blog.com

Video: Debunking the “Raise the Medicare Eligibility Age” Argument

The Bonddad Blog: A thought for Sunday: the best jobs program = allow Medicare eligibility at age 55

- by New Deal democrat Regular economic blogging will resume tomorrow (and I know, because the post is already cued up). In the meantime, consider the following thoughts over my Sunday morning coffee, which hopefully aren’t too incoherent…. One of the many ranting points I see on progressive blogs is against “the top 20%” who are apparently presumed to be the functional equivalent of Jamie Dimon. Not so. Many of “the top 20%,” in terms of wealth as opposed to income, are also known as “mom and dad.” If you look at the Census Bureau’s breakdown of average wealth by age group, the most prosperous are those on the verge of retirement. They’ve had 30 or 40 years to gradually build up savings. For example, a couple who each have $50,000 jobs (in today’s dollars) and live frugally by spending half of their net earnings and saving the other half (roughly giving them $30,000 savings per year) will become millionaires in about 25 years (thanks to compounding and return on investments). Obviously this isn’t the majority – the median wealth of people in the 55 – 64 cohort is something like $200,000 – but a non-trivial percentage of middle class workers ultimately reach this milestone. And you know what they would like to do more than anythings else? Retire! I know this not only from personal conversations with my fellow fossils, but also through a discussion with an accountant recently in which he told me that the number one reason most of his older clients haven’t retired yet is because they are afraid to before they are eligible for Medicare. Or they have to continue to work after age 65 themselves because they need their health insurance to cover their spouse until their spouse reaches age 65. Meanwhile, people like David Leonhardt in the New York Times are writing about Today’s Idled Youth,” describing how the ongoing Hard Times have hit the young perhaps harder than any other group. They bought into the American Dream of studying for a degree, becoming a professional of some sort, and hoping for a decent middle class existence. Instead, they are taking clerical or entry level service jobs, or even worse, unable to find a job. You can see where I’m going with this now, right? Here we have the older workers, hobbling to the finish line, but unable to end the race. And here we have young workers, itching to get started, and they can’t because there are no jobs, or no middle class jobs, for them. And the one thing that would cause the many older workers who have saved for retirement to be able to leave the workfoce, and clear the way for those frustrated younger workers, is guaranteed medical care. Fortunately, we have a program that provides exactly that: it’s called Medicare, and according to those already on it, it works really really well. And it works at much lower administrative costs than for-profit private coverage (If I recall correctly, Medicare’s administrative costs are something like 3%, vs. 15% for for-profit plans)(UPDATE: According to the CBO, Medicare’s administrative costs are 2%, vs. 17% for for-profit plans. And Medicare premiums have consistently risen less than private health insurer premiums) . And also unlike for-profit plans, in Medicare there’s no incentive to deny coverage. As in, yes you can buy into a private plan at age 60 for example, but it will be very expensive and you’d better pray they don’t come up with an exclusion if a disease of age catches up with you. Atrios has written a number of times about increasing Social Security payments. Balderdash, say I. If you really and truly want to make a dent in the persistent employment problem facing younger workers, allow anyone age 55 or above to buy into Medicare. Charge them annual premiums equal to what they would have to pay into Medicare at their same wage or salary until age 65 if they continued to work. You would be amazed to see how quickly Boomers can still move, cleaning out their offices and cubicles, when properly motivated. And then younger workers could move right in. It’ll never happen, of course, because it smacks of the New Deal, not the “21st Century” privatized solutions Barack Obama has touted since 2009. And of course the GOP will never allow it, not just because it smacks of the New Deal, but because if Obama came out in favor of it, they would oppose it for the simple reason of opposing everything Obama wants. But that doesn’t mean we shouldn’t acknowledge that it is a real solution to a real problem, and collectively rub Washington’s Very Serious People’s noses in it.
Source: blogspot.com

Taking Medicare’s eligibility age off the table

CARNEY: Again, as part of a big deal, part of a comprehensive package that reduces our deficit and achieves that $4-trillion goal that was set out by so many people in and outside of government a number of years ago, he would consider that the hard choice that includes the so-called chain CPI, in fact, he put that on the table in his proposal, but not in a cherry-picked or piecemeal way. That’s got to be part of a comprehensive package that asks that the burden be shared; that we don’t, as some in Congress want, ask seniors to bear the burden of further deficit reduction alone, or middle-class families who are struggling to send their kids to college, or parents of children who are disabled who rely on programs to help them get through.
Source: msnbc.com

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

Viewpoints: Rising Cost Of Tricare; GOP Needs To Better Explain Medicare Eligibility Age Issue; Don’t Forget Adult Immunizations

Minneapolis Star Tribune: Mental Health Needs The Nation’s Attention Millions of people in our country are struggling every day with mental illness — but most aren’t getting help. Many don’t have a support system. They may not have parents or friends who understand or have resources to help. They may not have health insurance that covers the cost of treatment. Or perhaps they feel ashamed or embarrassed to seek help, because mental illness still carries a stigma in our society. As my family searches for some type of meaning and comfort in the depths of our grief, we hold out hope that perhaps Andrew’s story will help people have a greater understanding and compassion for those who struggle with mental illness (Chris Bauer, 3/25). 
Source: kaiserhealthnews.org

OPINION: don't raise the Medicare eligibility age

Proponents of this idea say its time has come because starting in 2014, insurers will no longer be able to deny coverage to anyone because of age or health status, thanks to the Affordable Care Act.  People who can’t get coverage through the workplace will by then be able to shop for it on the state exchanges. But insurers will still be able to charge older people three times as much as younger folks. That would pose afinancial hardship for many seniors. The Kaiser Family Foundation estimates that two-thirds of 65 and 66–year-olds would have to pay at least $2,200 a year more for coverage than they would if they were on Medicare.
Source: publicintegrity.org

Medicare Eligibility Age on the Table? by Adele Stan

What the Democrats have been doing for the last four years is to look for, and then offer, concessions that they think might sate the Republicans. What Obama needs to start doing is to say, “OK, I’ve laid out my plan, and you say you refuse it. So what is your plan? Don’t say I have to provide more detail, I’ve provided plenty of detail. What do you want? I’m not making any new proposals until you give me a target to aim at. What, exactly, do you want?” Because the Republicans don’t have any reply. Their goal is to destroy Obama, not to achieve any particular policy. Sure, they don’t want to raise tax rates on people making over $250,000. They keep talking about “broadening the base and lowering rates” but until they get specific about what “tax expenditures” they are willing to remove there’s no way to know what they mean by that. It’s just a mantra repeated over and over until all meaning is gone. Until they say what programs they want cut, there’s no way to know what would be acceptable. They don’t want to say, because then people would blame them the cutting popular programs, so they won’t say, and as long as they won’t say there’s no way forward.
Source: washingtonmonthly.com

Brad DeLong : Raising the Medicare Eligibility Age Is a Really Bad Idea Blogging: Is This a Problem with the Media or with the Congressional Budget Office?

Director’s Blog: Raising the Ages of Eligibility for Medicare and Social Security: If the eligibility age was raised above 65, fewer people would be eligible for Medicare, and outlays for the program would decline relative to those projected under current law. CBO expects that most people affected by the change would obtain health insurance from other sources, primarily employers or other government programs, although some would have no health insurance. Federal spending on those other programs would increase, partially offsetting the Medicare savings. Many of the people who would otherwise have enrolled in Medicare would face higher premiums for health insurance, higher out-of-pocket costs for health care, or both.
Source: typepad.com

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August 19, 2013

Hellounitedmedicare.com UnitedHealthcare Medicare Solutions

Posted by:  :  Category: Medicare

HTTP/1.1 200 OK Date: Mon, 25 Mar 2013 22:19:05 GMT Server: Apache Set-Cookie: BIGipServeruhcmedicaresolutions-elrvip.uhcmedicaresolutions.com_11080=2823321354.18475.0000; expires=Mon, 25-Mar-2013 22:56:08 GMT; path=/ Vary: Accept-Encoding Content-Encoding: gzip Content-Length: 7096 Content-Type: text/html;charset=UTF-8
Source: statscrop.com

Video: Medicare Basic Overview by United Healthcare Medicare Solutions

Visionary Enterprises Inc. Blog

With the claim reconsideration app, you can search for your patient and claim online, enter a reason for reconsideration and then upload your documentation.  After submission, you receive a tracking number that allows you to check the status.  You will also be able to update and resubmit your request.
Source: veicorp.com

Fight the Flu at Southcreek Office Park

Coupons or At Your Office: If you wish to provide company paid coupons for your employees to use at the clinics or schedule a flu clinic visit at your office, contact Terri Murphy at 913-345-2220 or tmurphy@healthysolutionsinc.com
Source: southcreekofficepark.com

UnitedHealthcare cutting 191 Medicare telesales jobs in Florida

To assist affected employees, UnitedHealthcare created additional customer service positions to which those employees losing their jobs have been encouraged to apply. Employees hired into the new positions will be re-trained and remain with the company, according to Burns.
Source: ifawebnews.com

A Message from United Health Care @ Paragon Senior Health

State specific 2012 Dual Special Needs Plan (SNP) certification has been removed.  This means you will only be required to take the 2012 Dual Special Needs Plancertification module and will no longer have to be certified in each state you plan to sell.  This suggestion came from you.  We understand the importance of your time and we are committed to making your experience with UnitedHealthcare the best.  Keep in mind we will still offer state specific Dual SNP information during our AEP Readiness Training in your area.
Source: paragonseniorhealth.com

Four UnitedHealthcare Connecticut Medicare Advantage Plans Achieve Top NCQA Accreditation

UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with 780,000 physicians and other health care professionals and 5,900 hospitals and other care facilities nationwide. UnitedHealthcare serves more than 40 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.
Source: hcimarket.com

United Healthcare Acknowledges Payment Shortcomings : AAFP Leader Voices

Honestly, Dr. Cain, does United think we’ll swallow this load of hooey? They ask us to believe that: “United’s leaders” had no idea that for over two decades they’ve been forcing take-it-or-leave-it sub-Medicare contracts on family physicians (“Gambling in Casablanca? I’m shocked”); that, with all the resources of the country’s largest insurer, they’ve been unable during the past 14 months to identify physicians with those contracts; that they’re “developing solutions” while doing absolutely nothing; and that, icing on the cake, they “recognize the value of primary care” but, in the linked article say they will pay “incentive payments and fees GROWING (my caps) to a range of $0.45 to $3.30 PMPM” for medical home services. Dr. Cain, these are not decent, honorable people. They are con men: their words are lies, and their actions show nothing but contempt for the AAFP and family physicians. Every year, we read of these meetings, and every year things get worse. This approach does not work. Let me repeat: this approach DOES NOT WORK. The AAFP must take a strong adversarial approach if it wants to adaquately represent its members. A couple of suggestions: a major publicity campaign aimed at patients and employers outlining the actions/inactions of United and other insurers; a hot-line so physicians with these contracts can identify themselves, with the AAFP forwarding this information to United (along with the suggestion that, since their “leaders” didn’t know about these contracts, they re-process all claims from the last 10 years!); a blog in which physicians can report their experiences in renegociating their contracts; and, most importantly, the AAFP must walk out of the PCPCC, with a simple, public statement that we can no longer work in any capacity with organizations that are so hostile to our members and so damaging to our speciality. No family physicians, no medical home: this would carry some weight! We must refuse to allow our good name and reputation to be used as cover by these groups. The AAFP HAS to draw a line beyond which they will no longer tolerate this abuse of their membership. Thank you.
Source: aafp.org

VIDEO: Nationally Recognized TV Personality, Maria Antonieta Collins, Explains Medicare Benefits in First of Its Kind Spanish

Spanish-Language DVD –> MINNETONKA, Minn., Dec. 11 /PRNewswire/ — Award-winning journalist Maria Antonieta Collins has partnered with UnitedHealthcare to create the first-ever Spanish-language Medicare educational DVD for seniors and their caregivers. To view the Multimedia News Release, go to: http://www.prnewswire.com/mnr/unitedhealthcare/35269/ (Photo: http://www.newscom.com/cgi-bin/prnh/20081211/NY51614 ) With more than 2.3 million Hispanic seniors over the age of 65 eligible for Medicare in the U.S., UnitedHealthcare Medicare Solutions has produced a 45-minute step-by-step educational DVD version of its Medicare Made Clear guide (Medicare Explicado). The first-of-its-kind video, narrated by Collins in Spanish, will serve as a roadmap to help Spanish speaking Americans unravel the confusion behind Medicare eligibility requirements, benefits and plan options. Through her work as a national television personality on both Univision and Telemundo networks and an author of six published books, Collins brings a trusted presence to the complex and unfamiliar Medicare system to the Hispanic senior and caregiver community. "UnitedHealthcare Medicare Solutions understands the difficulty many encounter when they navigate the Medicare system. Medicare Explicado is intended to be an easy-to-understand tool," said Lina Gallardo, vice president, Ovations Marketing, a division of UnitedHealthcare. "Maria Antonieta Collins’ explanations on the educational DVD simplify the layers of Medicare to the Spanish-speaking community empowering Spanish-speaking seniors and their families to make informed health care decisions." "This project gives me a great opportunity to be with the people and to say, here we are, we are speaking Spanish to answer any doubts that you may have about Medicare in this DVD," stated Collins. "As a reporter I believe we must advocate for our community, and this project is a good example." The Spanish-language DVD is available free of charge by calling 1-800-678-4281. In addition, consumers can download an easy-to-read Spanish language Medicare guide at http://www.medicare-explicado.com/. About UnitedHealthcare Medicare Solutions UnitedHealthcare is a diversified health and well-being company that provides a full range of Medicare coverage options for individuals and group retirees through its affiliates. The family of UnitedHealthcare Medicare Solutions plans includes Part D Prescription Drug Plans, Medicare Supplement Insurance Plans and Medicare Advantage Plans featuring the UnitedHealth(R), AARP(R), SecureHorizons(R), SecureHorizons(R) MedicareDirect(TM), Evercare(R) or AmeriChoice(R) brand name. Plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization and a Prescription Drug Plans sponsor with a Medicare contract. Photo: http://www.newscom.com/cgi-bin/prnh/20081211/NY51614PRN Photo Desk, photodesk@prnewswire.comVideo: http://www.prnewswire.com/mnr/unitedhealthcare/35269/UnitedHealthcare Medicare Solutions Web Site: http://www.medicare-explicado.com/
Source: hispanicbusiness.com

United Healthcare Medicare Solutions

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Source: yourhealthwellness.org

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