What Medicare plan & supplemental protects best for fewest out

Posted by:  :  Category: Medicare

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spncity, I am almost certain he has a Medicare Advantage plan called Secure Horizons by United Health Care. This plan has the AARP nametag but has nothing to do with the plan. United pays a fee to AARP to use their name and make everything sound better. I was with this United Advantage plan for two years and it treated us good. No problems. In 2012 they increased their copays and deductibles so I switched us to BCBS Medicare Advantage. With both of these plans, along with others, there is no premium in addition to your Medicare insurance premium ($105/mo??). All of the plans available are listed on the medicare.gov website. Regarding the idea of going back to Medicare: I checked on this and found out that you can go back to plain old Medicare anytime; however, you may not be able to purchase a supplemental plan. That would be up to the issuer of the supplemental plan. My BIL has researched this for years and rechecks all the time. He says that all the supplemental plans have letter designations (such as Plan F) and each supplemental plan must provide the same coverage across the country. The only difference is the price. EX: He has regular Medicare and supplemental Plan F. So he shops for the best price on Plan F. For 2013 the best price was Mutual of Omaha, so that’s what he bought. I think he said it was $105/mo. About going back and forth: I probably couldn’t go back as most likely an insurance company wouldn’t sell me a supplemental plan because of preexisting conditions. That may change with Obamacare as they aren’t supposed to hold that against you. I’ll believe that when I see it. I may not change back regardless, but it would be nice to have that option. Hope this helps and if anyone has more information I’d like for you to post also as this is a big concern for everyone. The more information the better. Edited to add that prescription drugs are covered by most Advantage Plans but price per drug changes every year. Some of mine are even free for a 90 day supply. The Advantage Plans are "advantageous" and that is why they are always targeted for cuts by the government. A lot of older people have those plans and that is why the government treads lightly.
Source: early-retirement.org

Video: Medicare Home Health Benefits in Broward: Medical Home Care

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

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

Blue Medicare Regional PPO Plan

With so many different providers, it’s often a challenge to find Medicare providers you can truly trust. It’s tough to know which companies are reliable and which are not. Florida seniors overwhelmingly choose Florida Blue as their Medicare provider and the Blue Medicare plans have earned a reputation as a dependable, top of the line option. Florida Blue has earned a solid reputation built on generations of happy, satisfied customers. With a Blue Medicare health plan, you’re getting more than a piece of paper, but a promise that when you need health care, you can get it- no questions asked.
Source: mioti.com

Postal Service’s financial plan: Make Medicare pay our bills

“The primary policy decision for Congress to make with respect to USPS’s proposed health care plan is whether to increase postal retirees’ use of  Medicare, which is already facing funding challenges,” the Government Accountability Office reports. “This is because USPS’s proposal would essentially decrease USPS costs but increase Medicare costs.”
Source: washingtonexaminer.com

Blue Medicare Regional PPO Plan

Cost is a major concern for most of us these days and hardly anyone passes on the chance to save a few dollars. With a Blue Medicare Regional PPO plan, saving is easy. With $0 monthly plan premiums, moderate out-of-pocket expenses and more, it’s easy to find the perfect plan to fit your needs and your wallet. That’s great news for seniors on a fixed income and exactly why so many Floridians choose Florida Blue as their Medicare health plan option. Plus, with no deductible for preventive care, you can get vaccines, routine screenings and more easily and conveniently.
Source: ruthiehendricks.com

Do you Have Medicare Questions? SHIP of Union County will be at Overlook Downtown Beginning in September

Programs at SAGE Eldercare include: HomeCare; Meals On Wheels; Spend-A-Day Adult Day Health Center; GPS (Guidance, Planning and Support) Services; InfoCare free information and referral service; Fall Prevention Initiative; Home Repair Service; Grocery Shopping and Errand Service; Bill Paying Service; Holistic Living Services; Alzheimer’s and PREP caregiver support groups; Community Education; and Union County Medicare SHIP (State Health Insurance Assistance Program).  In addition, SAGE has operated a Furniture Restoration Workshop, run by volunteers who specialize in caning and rushing chairs and refinishing furniture, and a Resale Shop for more than 50 years.  Both provide essential funding that supports the organization’s programs and services for older adults in the community. 
Source: thealternativepress.com

Secretary Sebelius: Medicare Helps Millions

Another way we’re strengthening Medicare is by rooting out fraud, waste and abuse in the system – ensuring we protect taxpayer dollars and the health of our seniors. Earlier this year, Attorney General Eric Holder and I announced another take-down of Medicare fraud schemes involving hundreds of millions of taxpayer dollars in cities across the country. The law makes it harder for criminals to submit fraudulent claims and get paid in the first place, and our work has resulted in record Medicare fraud recoveries: Nearly $15 billion in the last four years.
Source: aarp.org

Do you Have Medicare Questions? SHIP of Union County will be at Overlook Downtown Beginning in September

Posted by:  :  Category: Medicare

Programs at SAGE Eldercare include: HomeCare; Meals On Wheels; Spend-A-Day Adult Day Health Center; GPS (Guidance, Planning and Support) Services; InfoCare free information and referral service; Fall Prevention Initiative; Home Repair Service; Grocery Shopping and Errand Service; Bill Paying Service; Holistic Living Services; Alzheimer’s and PREP caregiver support groups; Community Education; and Union County Medicare SHIP (State Health Insurance Assistance Program).  In addition, SAGE has operated a Furniture Restoration Workshop, run by volunteers who specialize in caning and rushing chairs and refinishing furniture, and a Resale Shop for more than 50 years.  Both provide essential funding that supports the organization’s programs and services for older adults in the community. 
Source: thealternativepress.com

Video: Medicare Overview

Doctors Fleeing Medicare? Not So Fast, Feds Say

No consolation for the folks at the American Medical Association, who point to financial pressure on doctors who take part in Medicare. “While Medicare physician payment rates have remained flat since 2001, practice costs have increased by more than 20 percent due to inflation, leaving physicians with a huge gap between what Medicare pays and what it costs to care for seniors,” AMA President Dr. Ardis Hoven told Forbes.
Source: wamc.org

Income Thresholds For Medicare Part B And Part D Premiums

While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

GAO: Postal Health Plan Could Add To Retired Workers’ Costs, Impact Medicare

The Hill: Proposed USPS Health Care Shift Could Add Slight Strain To Medicare The cash-strapped U.S. Postal Service’s push to run its own health care plan could add — if only slightly — to Medicare’s financial strains, according to a new report. The Government Accountability Office (GAO) says that the USPS’s proposal to opt out of a federal health care plan would likely lead to billions of dollars in savings. But the GAO also noted that a large chunk of the savings would come from making more retired postal workers rely on Medicare services (Becker, 8/19).
Source: kaiserhealthnews.org

Medicare to punish 24 state hospitals for high readmissions

Facing fines higher than the national average are: Bristol Hospital (.85 percent); Greenwich Hospital (.41 percent); Griffin Hospital in Derby (.97 percent); MidState Medical Center in Meriden (.78 percent); Milford Hospital (.76 percent); and St. Francis Hospital & Medical Center in Hartford (.39 percent). The other state hospitals will face lower penalties, including Lawrence & Memorial in New London, which will lose .13 percent of every Medicare payment for a patient stay; Bridgeport Hospital (.2 percent); Hartford Hospital (.1 percent); and Charlotte Hungerford in Torrington (.04 percent).
Source: middletownpress.com

Medicare Data Access for Transparency and Accountability Act of 2013

Grassley maintained that taxpayers have "a right to see how their hard-earned dollars are being spent" and "there should not be a special exemption for hard-earned dollars that happen to be spent through Medicare." Further, "if doctors know that each claim they make will be publicly available, it might deter some wasteful practices and overbilling," he noted. For example, Grassley cited how in 2011 the Wall Street Journal, "using only a small portion of Medicare claims data, was able to identify suspicious billing patterns and potential abuses of the Medicare program." In fact, WSJ found "cases where Medicare paid millions to a physician sometimes for several years, before those questionable payments stopped."
Source: policymed.com

Additional 0.9 percent Medicare tax on wages starts January 1st

Posted by:  :  Category: Medicare

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For partners in a general partnership and shareholders in an S corporation, the tax applies to earned income that is paid as compensation to individuals holding an interest in the entity. Partnership income that passes through to a general partner is treated as self-employment income and is also subject to the tax, assuming the income exceeds the applicable thresholds. However, partnership income allocated to a limited partner is not treated as self-employment and would not be subject to the 0.9 percent tax. Furthermore, under current law, income that passes through to S corporation shareholders is not treated as earned income and would not be subject to the tax.
Source: pntax.com

Video: Reality check: Tax rates & Medicare

Capital Gains and Dividend Income Tax Rates Scheduled to Increase in 2013: Added Impact of New Medicare Contribution Tax

The significant increase in capital gains rates and taxes on dividend income have already resulted in taxpayers attempting to realize gains or accelerated the receipt of dividends from closely held corporations before the end of this year. If the rates do increase, i.e., Congress does not resolve the fiscal tax cliff in a manner that reduces or eliminates the anticipated tax rate hikes, then the new tax rates will certainly have a widespread and dramatic effect on future tax planning for all taxpayers, including closely held businesses and investors. For example, many owners of appreciated real property may prefer to engage in tax-free exchanges instead of having a preference for cash sales. From a merger and acquisition standpoint, privately owned companies looking to sell out may want to either postpone the sale of its business or consider being acquire in a tax-free reorganization or perhaps engage in a joint venture which could be partially taxed to the extent cash is received. With higher rates also brings along a greater tax benefit from depreciation and other tax deductions, including tax credits. The change in rate structure may also affect the preferred entity form for many businesses particularly if the much talked about reduction in the corporate income tax rate occurs. There could be a wide disparity then in the rate of tax a regular or C corporation pays instead of a flow through entity used by individuals in operating a closely held business or professional service organization causing the entity owners to reassess the best tax form for doing business.
Source: foxrothschild.com

Massachusetts / Rhode Island NATP Chapter: New IRS Form 8959

The IRS has issued a draft of its new Form 8959 which will be used to calculate the portion (if any) of the Medicare Tax W-2 withholding which may be applied against income tax liability arising from the 3.8% surtax on certain high-income taxpayers. The issue for taxpayers and tax preparers is that the medicare surtax is an addition to the regular income tax which applies, so it is included in the calculation of required payments/withholding necessary to avoid an underpaid tax penalty.  If the payroll system gets it right and withholds more than the otherwise required 1.45% on payroll to which the surtax applies, the Form 8959 then Identifies this supplemental medicare withholding included in box #6 on the W-2 form and reports it as part of the total federal income tax withholding on line #62 of Form 1040. Likewise, there is a separate section on the form for calculating the portion (if any) of the medicare tax on self-employment and/or railroad retirement income which is supplemental and, therefore, eligible for reclassification as income tax withholding reported on line #62. This form, although complicated in presentation because almost everything associated with Obama Care is complicated, appears to be something which good tax preparation software can handle without the active involvement of the tax preparer.
Source: blogspot.com

The effect of the Medicare tax rate increase when exercising non qualified stock options

Each blog includes the special feature,  “Dan’s Moral”,  as a wrap-up commentary, direct from blog author, Dan Langworthy.   Check “Dan’s Moral” in other blogs on Equity Compensation Advisor by category of interest.  We hope you find what you are looking for, however, Dan welcomes your requests for new equity reward topics that may interest you.  Contact Dan Langworthy by commenting below.
Source: equity-compensation.com

The effect of Obamacare’s Medicare payroll tax rate hike on NBA Players

“If only Herschel cared more about his current responsibilities, and less about pushups and situps-TO” How do you know he isn’t? Do you have information that he isn’t taking care of his duties as a father, or are you just pissed he knocked up his smoking hot, younger girlfriend? Posted in Herschel Walker New Baby Daddy To Former Florida State Bombshell by
Source: terezowens.com

Medicare Tax Increase Effective December 31, 2012

401(k) 1099 2012 ACO Anthem / Healthlink Appeals captives Civil Unions CLASS Act COBRA Compliance Defined Contribution Employee Rights Employer Mandate employer rules ERRP Essential Benefits Exchange FSA Grandfathering Health Care Reform Health Outcomes HICA HIPAA HSA Human Resources Individual Insurance J.W. Terrill labor relations board Medical Claims Assessment Medicare MLR Non-Discrimination OTC PCORI Preventive Care Religious Exemption Repeal SBC SIIA Small Group Small Group Tax Credit Taxes W2 Wellness
Source: jwterrill.com

The New 0.9% Medicare Tax: Watch Out for Withholding Issues

Under the health care act, starting in 2013, taxpayers with earned income over $200,000 per year ($250,000 for joint filers and $125,000 for married filing separately) must pay an additional 0.9% Medicare tax on the excess earnings. Employers are required to withhold the tax beginning in the pay period in which wages exceed $200,000 for the calendar year — without regard to the employee’s filing status or income from other sources. So, it’s possible your employer:
Source: gallina.com

Understanding Medicare Statements

Posted by:  :  Category: Medicare

You should compare the information on your MSN with bills, statements and receipts from your health care providers and suppliers. Do the dates, billing codes and the descriptions of services you received match? In some instances, your MSN may include valid charges for services or supplies you weren’t aware of having received — such as for medical consultations or tests. But, as a general rule, the dates and codes should match. If you don’t see codes on your provider’s paperwork, ask for copies that include them.
Source: aarp.org

Video: AFMC Medicare Services – Medicare Summary Notice

CMS Redesigns Medicare Summary Notices : Health Industry Washington Watch

CMS has announced the redesign of the beneficiary Medicare Summary Notice (MSN) to enhance clarity and help seniors identify potential fraud, waste, and abuse. The MSN lists all services or supplies that providers and suppliers billed to Medicare during a 3-month period on behalf of the beneficiary, which CMS notes will help beneficiaries spot claims for services they never received.  In a press release announcing the MSN redesign, CMS also touted its anti-fraud efforts, noting that the since March 2011, the agency has revoked the Medicare billing number of 14,663 providers and suppliers. According to CMS, the number of revocations has quadrupled in 18 states since ACA screening and review requirements were enacted and proactive data analysis was implemented to identify potential license discrepancies of enrolled individuals and entities.
Source: healthindustrywashingtonwatch.com

Medicare Fights Fraud With Sent Summary Notice

The Medicare summary notice will come throughout the month of June and the goal is to have each Medicare user more aware of their rights, services and benefits. By becoming more aware, they can tell if a false agency or person is trying to scam them.
Source: wibw.com

CMS Redesigns Medicare Summary Notices 

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

How to Read Your Part B Medicare Statement

Medical procedures and services are assigned billing codes. You have the right to receive an itemized billing statement that lists each medical service you received. If you need an itemized statement, contact your doctor. Compare the billing code on your MSN with the code that appears on the billing statement you received from your doctor. If the codes are different, or if you didn’t receive the medical service indicated, contact the doctor who is making the claim. It may be a simple mistake that the doctor’s office can easily correct. If the office does not resolve your concerns, call Medicare at 1-800-MEDICARE (1-800-633-4227).
Source: aarp.org

2014 Medicare Part D Costs to Remain Stable

Posted by:  :  Category: Medicare

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Remember, the Medicare Annual Enrollment Period (AEP) is in exactly two months, lasting from October 15 to December 7. During this time, you can enroll in, drop, or change your Medicare Part D and/or Medicare Advantage coverage. By AEP, the costs for all 2014 Part D plans should be finalized. With plan benefits and costs changing each year, consider reviewing your Part D coverage options during this time to make sure you are still enrolled in the best plan for your needs. You can use an online plan comparison tool, like the one offered at Medicare.gov or the eHealth Medicare plan comparison tool, to compare costs between plans side-by-side and find the right plan for you.
Source: ehealthmedicare.com

Video: Understanding Medicare – Part D Prescription Drug Coverage

Explaining Health Care Reform: Key Changes to the Medicare Part D Drug Benefit Coverage Gap

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The health reform law, as modified by the Health Care and Education Reconciliation Act of 2010 which passed the House of Representatives on March 21, 2010 and is under consideration in the Senate, makes several key changes to the Medicare Part D drug benefit to reduce Part D enrollees’ out-of-pocket liability when they reach the coverage gap, known as the “doughnut hole”. This explainer walks through how those provisions would work.
Source: kff.org

Medicare Part D continues to improve access to drugs

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

Medicare Coverage Frequently Asked Questions

If you find that you do not qualify for Extra Help, you can try to cut down your medication costs by switching to generic drugs, using preferred pharmacies, and/or using mail-order services that offer drugs at discounted prices. In addition, you have the opportunity to compare and change drug plans if you find that your plan is not providing enough coverage for your medications. You may change plans during Annual Enrollment Period (AEP), which begins on October 15 and runs through December 7. However, please be aware that if you are responsible for a Part D late enrollment penalty, this penalty will roll over into your new drug plan if you do choose to switch.
Source: planprescriber.com

Medicare Part D: Don’t Mess with Success

Medicare Part D provides affordable outpatient prescription drug coverage for seniors and people with disabilities and has been hugely successful by many measures.  According to the Congressional Budget Office (CBO), the Part D program has cost the government 45 percent less than initially expected when Congress approved the Medicare Modernization Act of 2003.  Ninety percent of Part D beneficiaries are satisfied with the program.  And according to a study released earlier this year, improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with congestive heart failure and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare.
Source: azhealthconnections.com

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

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

Survey Finds Seniors Satisfied With Medicare Part D

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

Marci’s Medicare Answers

Dear Job, Yes, Medicare covers some shots and vaccines. However, the way Medicare covers them depends on which shot or vaccine you need. Medicare Part D, also known as the Medicare prescription drug benefit, covers most shots and vaccines that you get. However, Medicare Part B, the medical insurance part of Medicare, may cover certain shots and vaccines in some situations. Specifically, Part B covers vaccines to prevent the flu, pneumonia and hepatitis B. Keep in mind that Part B will cover your hepatitis B shot only if you are at medium-to-high risk for hepatitis B. If you are at low risk for hepatitis B, your shot will be covered under Part D. Medicare Part B also covers shots, after you have been exposed to a dangerous virus or disease. For example, if you step on a rusty nail, Medicare Part B will cover your tetanus shot to treat the spread of the tetanus bacteria. All other shots or vaccines, other than the ones mentioned above, are generally covered under Part D. Medicare Part D plans must include all commercially available vaccines on their formulary, or list of covered drugs, including the vaccine for shingles. Before you get a shot or vaccine, check with your Part D plan to see where you should get your shot at the lowest cost. —Marci
Source: homeboundresources.com

Closing the Medicare Part D Coverage Gap

The health care law adds benefits to help make your Medicare prescription drug coverage more affordable. If you reach the Medicare Part D coverage gap, you can get discounts on your prescription drugs. The discounts will gradually increase until the coverage gap disappears in 2020.
Source: aarp.org

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August 24, 2013

CMS Contractor Reveals Top Reasons Medicare Payments Are Denied

Posted by:  :  Category: Medicare

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Reason code 55H4D occurs when therapy services were determined to not require a therapist. Clinical documentation must support either the services provided were so complex they could only be provided by a therapist or the condition of the patient was so complex the services could only be provided by a therapist. If the services could be safely provided by anyone other than a therapist, they do not qualify for payment as therapy services. The guidelines regarding therapy services provided under the home health benefit are found in the CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 40.2.
Source: homehealthnews.org

Video: Medicare denial code

Appealing Medicare Denials of New Medical Technologies

In addition to filing reconsideration requests and supporting beneficiary challenges, Providers may appeal individual denied Medicare claims that are denied through the five-step Medicare appeal process (redetermination, reconsideration, ALJ, Medicare Appeals Council).  Providers or patients may also appeal denied claims through their insurer’s appeal process.  However, less than 10% of claims denied by commercial payers and less than 2% of claims denied by Medicare are appealed.  Every payer anticipates that most denied claims will not be appealed.  Nonetheless, reported statistics show that most parties that appeal denied claims up to the administrative law judge level are successful.  Thus, it behooves a provider or beneficiary to appeal the denied claim at least through the ALJ level.  Such claims are favorably reviewed even in the face of a non-coverage LCD because ALJ’s are not bound by a contractor’s LCD, although they must give deference to it.  This is particularly true when the LCD does not appear to reflect the literature or the consensus of medical opinion.
Source: wphealthcarenews.com

Medical Billing And Coding: Medicare common denials

Denial reason: Charges exceed your contracted/ legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability).
Source: blogspot.com

Medicare Issues Guidance to Hospitals for Part B Rebilling of Denied Inpatient Claims

The article contains important information for coding and submission of claims, including timing, bill types, condition codes, treatment authorization codes and required remarks.  Further, the article makes clear that hospitals may also bill separately for outpatient services provided in the three-day (or one-day) payment window and that rebilling of denied inpatient claims will not impact skilled nursing facility eligibility.  Finally, hospitals submitting Part B  inpatient claims during the interim rebilling policy are acknowledging that the Part B claim is a duplicate of a denied Part A claim, that no payment will be made for items and services included on the Part A claim and that any amounts collected from the beneficiary for the Part A claim will be refunded to the beneficiary.  CMS will establish permanent policy changes through notice and comment rulemaking.  The associated Proposed Rule was published in the Federal Register on March 18, 2013, and comments are due by 5 P.M. on May 17, 2013.  
Source: hallrender.com

EPA employee stole $886K from the agency

“There appears to be corruption to the umpteenth degree,” said Louisiana Republican Sen. David Vitter. “I think it’s appalling that Administrator McCarthy and former acting Administrator Bob Perciasepe could claim that sequester is depriving the agency of important resources when in fact their own employees are stealing from the government.”
Source: dailycaller.com

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August 24, 2013

Bupa acquires Richmond Care Villages

Posted by:  :  Category: Medicare

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Tim Edghill, head of mergers and acquisitions at Jones Lang LaSalle Corporate Finance said: “This transaction represents a successful outcome for both our client and Bupa.  It demonstrates the depth of interest in the retirement village sector which will continue to grow, as lifestyle and choice become an increasingly important factor alongside care support in old age.”
Source: careinfo.org

Video: Bupa. Find a Healthier You – Thanks Mum!

Tune into Radio Carly: Introducing Nathalie from Easy Peasy Kids: a BUPA Health Influencer award winner

“My blog is mainly behaviour related, looking at the bigger picture and simple life lessons. I cover child behaviour and looking at the world through the eyes of a child. The blog started in May 2011. It features many aspects of behaviour from how we can feel as parents, what children may be feeling, behaviour in social media and even my own behaviour.
Source: blogspot.com

Citizens UK ask Bupa for Living Wage

The action is part of a wider Citizens UK Social Care campaign which came as a result of a listening campaign, in Citizens UK institutions across the country, about the standards of care for the elderly. In light of the national spotlight on care for the elderly, member communities involved in thousands of conversations on the issue, unanimously agreed to take up the social care campaign.
Source: citizensuk.org

Farah versus Bekele and Gebrselassie: BUPA Great North Run assembles greatest half marathon ever! release from Nova, note by Larry Eder

Haile Gebreselassie is the Emperor. The man has more dynamism than any other athlete from the African continent. Kenenisa Bekele, the world record holder at 5,000m and 10,000m, is seeing that it is time to move up in distances, and the half marathon may suit him.
Source: runblogrun.com

Bupa Malta makes it an eleven seasons supporting Bupa Luxol Basketball Team.

Bupa Malta has a passion for progress in business and in sport, and what better way to showcase this passion than through the sponsorship of Luxol in their various competitions? Bupa Malta undertook the Luxol sponsorships in 2003, with the objective of widening the talent pool of Maltese basketball by investing in a top club and giving it sufficient resource to assist coaching and player recruitment.
Source: sportinmalta.com

Running the BUPA 10k today

The week in early May that we spent at the hospital was maybe the most stressful, worrying time of my life. But we couldn’t believe how amazing the care was –  the intensive care ward and the ward Penny was moved to a few days after surgery were new, excellent facilities, the doctors and nurses worked hard and were really friendly and helpful, and we were able to stay at the hospital with Penny for the whole week. So in January this year, when I felt Penny had definitively recovered and Spence and I started to feel like things were ‘normal’ again, I decided to run the BUPA 10k to raise money for a hospital that does so much to help families and children around the UK. I raised over £800! And managed to get to the end of the run despite not having run since university (I started training 3 months ago).
Source: andiamomummy.com

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August 24, 2013

CMS finalizes wage index and payment rates for the Medicare hospice benefit

Posted by:  :  Category: Medicare

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Coding clarification CMS has clarified that hospice providers should not use non-specific diagnoses.  Diagnoses should be assigned based on the reason for hospice care. This is not a new regulation. It is a long-standing rule that hospices should follow all ICD-9-CM guidelines. CMS recognizes that there are process and system changes that need to be put in place. With that in mind, the rule states that claims received with these codes in the principal diagnosis field will be returned to the provider for more definitive coding of the principal diagnosis and additional diagnoses, effective for claims dated on or after
Source: wordpress.com

Video: Hospice & Medicare Rules & Regs – Pt 1

Medicare Lags In Project to Expand Hospice

The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.
Source: kaiserhealthnews.org

More on hospice reducing Medicare expenditures

2013 Budget ACA AcademyHealth Affordable Care Act alzheimers disease Amendment One Balancing the budget is a progressive priority bowles-simpson budget deficit cadillac tax cbo Charles Blahous CLASS Act college tuition comparative health systems cost effectiveness debt ceiling debt limit deficit Disability dual eligibles Economics of Sports end of life fiscal commission fiscal commission gridlock HCFO health care costs health reform heuristics hospice Hospice/Palliative Care hospitals HRSA NegReg individual mandate informal caregiving insurance exchange IPAB Long Term Care Long Term Care Insurance Medicaid Medicaid expansion medical school costs Medicare Medicare Advantage Medicare Advantage SNP National Flood Insurance Program NC Marriage Amendment NC Medicaid plan Negotiated Rulemaking NHS Obamacare On The Record Patients’ Choice Act Paul Ryan pharmaceuticals POLST premium support primary care physicians rationing RWJF skin in the game smoking smoking cessation social cost of smoking Social Security Social Security Disability Insurance Super Committee Supreme Court tax expenditure tax reform tax treatment of employer provided insurance The cost of smoking voterid Wyden/Ryan
Source: wordpress.com

Saving Money While Providing Benefit In Medicare: A Standard Applied Only To Hospice

Hospice is an interdisciplinary approach to caring for persons believed to be within 6 months of death and can plausibly reduce Medicare expenditures by avoiding expensive hospitalizations in the last days and weeks of life. At its best, hospice typically replaces that default with the patients’ desire for a less medicalized death in the patients’ home, while maximizing quality of life. A recent paper published in Health Affairs confirmed past work showing that hospice reduces Medicare spending as compared to what it would have been during the most common periods of usage observed in Medicare. And hospice has been shown to improve patient and family member quality of life. Hospice has passed the market test; around half of all Medicare decedents used at least 1 day prior to death in 2010.
Source: healthaffairs.org

RAC Alert: How to Bill Medicare for Hospice Patients When You Are Not the Hospice Provider of File

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his/her terminal illness during any period his/her hospice benefit election is in force, except for professional services of an attending physician, which may include a nurse practitioner. If the attending physician, who may be a nurse practitioner, is an employee of the designated hospice, he or she may
Source: managemypractice.com

HPH Hospice Fined $1 Million for Medicaid, Medicare Fraud

A hospice that operates in Pasco, Hernando and Citrus counties has agreed to pay $1 million for submitting false claims to Medicare and Medicaid. The U.S. Attorney’s Office for the Middle District of Florida announced today the hospice has agreed to pay the fine for violations taking place from 2005 to 2010. The federal government alleged that HPH Hospice submitted false claims for patients who did not need end-of-life care. Two former HPH staffers claimed the hospice admitted ineligible patients to meet targets imposed by hospice managers. They were also discouaged from discharging patients who did not need hospice care. The settlement also resolves allegations that HPH billed the government at reimbursement rates higher than it was entitled to and gave illegal kickbacks when it provided free services to skilled nursing facilities in exchange for patient referrals. HPH operates facilities in New Port Richey, Dade City, Brooksville, Lecanto and Hudson.
Source: usf.edu

In FY 2012: Medicare Hospice Wage Index Increases 2.5%, Other Hospice Changes

Beginning October 2012, hospices will be required to start collecting quality of care data for submission in 2013.   This is the implementation of a hospice quality reporting program, as mandated by the Accountable Care Act (ACA).  Under the Quality Assessment and Performance Improvement (QAPI) program, hospices are required to submit data on quality measures to CMS or face a two-percentage point reduction to their annual market basket update, starting FY 2014.  Hospices may voluntarily being collecting QAPI data in October 2011 for submission in 2012.
Source: hallrender.com

DOJ Accuses Hospice Giant Chemed Of Medicare Fraud, Shares Plunge

“Vitas billed three straight days of crisis care for a patient, even though the patient’s medical records do not indicate that the patient required crisis care and, indeed, reflect that the patient was playing bingo part of the time,” DOJ said in a press release.
Source: investors.com

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August 24, 2013

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Description: HTTP 404. The resource you are looking for (or one of its dependencies) could have been removed, had its name changed, or is temporarily unavailable.  Please review the following URL and make sure that it is spelled correctly. Requested URL: /404.aspx
Source: federaldaily.com

Video: Medicare Part B Cost and Late Enrollment Penalty

Part 1 of 6: Does Medicare or Traditional Health Insurance Pay for Elder Care Services in Indianapolis Indiana?

Julie Sullivan is the Owner at GreatCare of Indianapolis IN. GreatCare is a licensed, personal services agency, providing in-home care services to the Indianapolis, Indiana and surrounding areas. We serve the personal health and daily care needs of seniors or individuals who prefer to stay at home, but require assistance with everyday activities, such as dressing, personal hygiene, meal preparation, laundry or errands. Our team of certified nurse aids and home health aids can provide you with personalized, in-home care services to meet your needs, including: Daytime hourly in-home care Temporary or post-hospital respite care 24-hour, around-the-clock home care Morning and evening care Overnight / Slumber care In addition, we offer our Care Compass service, to assist in setting the course for the next stage in your loved ones life. We guide you through the currents of aging, and help you find your true north. Our licensed nurses, with experience in hospice and geriatric care, will help guide you through the complex and often sensitive journey of selecting an in-home care service, and will provide a smooth transition to a new way of life for your loved one, without the anxiety and fear.
Source: ineedgreatcare.com

FAH Submits Letter to Ways & Means Chairman Camp Regarding Medicare Beneficiary Payment Reforms

Hospitals have withstood $95 billion in Medicare cuts in just the past three years alone.  Over the next ten years, hospitals are facing nearly a half trillion in cuts.  These cuts have already resulted in reduced services, reduced access to care, and thousands of job cuts across health care.  Hospitals have done their part and have implemented a number of reforms that contribute to the cost reduction and savings trends occurring now.  As policymakers look for further areas of reform, FAH believes that these cost-sharing proposals are an appropriate area for discussion and, ultimately, modernization.
Source: fahpolicy.org

Medicare Supplements (Medigap) For Dummies

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

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

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

The ABCs and Part D of Medicare

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

Ask The Experts: Retirement

When I called Blue Cross, they indicated that if my wife continues with her plan, there is no reason to take Part B. Social Security warns me about the 10 percent-per-year cost increase and the open enrollment period being three months and I have to wait until the following July. I am still working, basically self-employed. Any advice?
Source: federaltimes.com

Understanding Medicare Premiums; Now Projected to Grow Slower

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

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August 24, 2013

I Am A Vet … and so Confused about My Medicare? » Toni Says

Posted by:  :  Category: Medicare

You and my husband must have been in the Marines together!  He feels the same way. “Part B” covers everything, except an in-hospital stay, which is covered on Part A.  When you are taken to a hospital, by law EMS has to take you to the closest hospital and unfortunately, that may not be the VA hospital.   You will receive bills for everything, except your hospital stay, which is covered under “Part A” if you don’t have “Part B”. I know this because my husband is fighting bills from over 4 years ago, when he was not old enough for Medicare and was ambulanced to Methodist Hospital in Sugar Land, Tx. He was told by the VA that due to him having a 60% disability, he would never have to pay anything at the VA and that if he is sent to another hospital due to an emergency that the VA would pick up the charges.
Source: tonisays.com

Video: Medicare Part B Cost and Late Enrollment Penalty

Ask The Experts: Retirement

When I called Blue Cross, they indicated that if my wife continues with her plan, there is no reason to take Part B. Social Security warns me about the 10 percent-per-year cost increase and the open enrollment period being three months and I have to wait until the following July. I am still working, basically self-employed. Any advice?
Source: federaltimes.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

The Medicare Coach: AFFORDABLE CARE ACT

The ACA provisioin extending health insurance coverage to dependent children until age 26 did not extend to TRICARE beneficiaries.  But the Ike Skelton National Defense Authorization Act for fiscal year 2010 authorized a new TRICARE option know as TRICARE Young Adult program, that allows children up to age 26 who lose coverage under a parent’s TRICARE policy, and who are not otherwise eligible to enroll in an employer-sponsored plan, to purchase TRICARE coverage for themselves.
Source: themedicarecoach.com

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

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

Understanding Medicare for Working Individuals

However, if you choose to delay enrollment as a result of existing health coverage based on current employment, which does not include COBRA or retiree health coverage, you can enroll in Part A and/or Part B at any time without penalty. When your employment ends, you then have an 8-month Special Enrollment Period (SEP) to sign up for Part A and/or Part B coverage without penalty. After that, you would be subject to late enrollment penalties.
Source: ehealthmedicare.com

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