Medicaid Expansion through Premium Assistance: Key Issues for Beneficiaries in Arkansas’ Section 1115 Demonstration Waiver Proposal

Posted by:  :  Category: Medicare

As states weigh whether to expand their Medicaid programs as provided by the Affordable Care Act, a few states have considered using Medicaid funds as premium assistance to purchase Marketplace (formerly called Exchange) coverage for newly eligible Medicaid beneficiaries, as an alternative to providing coverage through their traditional Medicaid programs.  The Department of Health and Human Services has indicated that it will consider approving a limited number of such demonstrations.  To date, Arkansas is the first of two states to enact legislation authorizing the expansion of its Medicaid program through premium assistance, and on June 24, 2013, Arkansas released for public comment its draft § 1115 demonstration waiver application. This issue brief provides background about Medicaid premium assistance in the individual health insurance market, summarizes major components of Arkansas’ proposal, and considers key issues affecting beneficiaries.
Source: kff.org

Video: Arkansas Medicare Supplements

The “private option” for Medicaid expansion and budget neutrality

Earlier this month, the state Department of Human Services sent its request to the feds for a waiver of federal rules so the state can proceed with the so-called “private option” for Medicaid expansion. One requirement of the plan — which will use Medicaid funds to fully cover the premiums of private health insurance plans for low-income Arkansans — is that the state demonstrate “budget neutrality”: The “private option” is not supposed to cost more than traditional Medicaid expansion would. Many have expressed skepticism that this is an achievable goal for the state given the wealth of empirical evidence that Medicaid is cheaper than private insurance. During the public comment period, in addition to the hubbub over community health centers, a few groups raised questions about budget neutrality. That includes Americans for Prosperity, though it’s been a bit peculiar to see them harp on this particular point — if traditional Medicaid expansion is cheaper, that seems to argue for, well, traditional Medicaid expansion, which is probably not on AFP’s agenda. Voices on the left have brought it up as well. As Anna Strong of Arkansas Advocates wrote, “It is clear the waiver does not go into detail about the evaluation of budget neutrality for the demonstration, a requirement for federal approval.” And it’s true. The waiver request is vague on this point. Arkansas is asking the feds for a 3-year “Demonstration waiver” — basically, permission to run an experiment. The experiment includes various hypotheses about how the “private option” will work, including the hypothesis that it will be comparable in cost to traditional Medicaid. But unlike the other hypotheses, which articulate clear measurement mechanisms, the “cost comparability” hypothesis lists the “evaluation approach” as TBD; the “data sources” section is blank. (The final waiver request includes a budget neutrality spreadsheet not included in the original draft, but this merely asserts that the costs will be the same.) I asked DHS about this when they first released the draft of the waiver request. A spokesperson responded: The hypotheses are designed to support a more formalized academic evaluation whereas the Special Terms and Conditions will include the requirements for achieving budget neutrality. Budget neutrality requirements will be addressed in the Special Terms and Conditions to be drafted by CMS [Centers for Medicaid and Medicare Services] following the waiver submission. In other words, the question of how to evaluate whether the “private option” costs more than traditional Medicaid will ultimately be up to the feds. The state and CMS are currently discussing  the development of an evaluation approach; if the waiver is approved, it will include instructions from CMS on how to test for budget neutrality. DHS has a controversial theory (backed by an actuarial study) about why the “private option” will cost the same, or even less. Its hypothesis states that the cost will be comparable to traditional Medicaid “assuming adjustments … to achieve access.” That “assuming adjustments” bit is the key: DHS argues that if traditional Medicaid is expanded, the Medicaid program would have to increase reimbursement rates to providers in order to achieve adequate access. By how much? All the way up to private rates. The Medicaid program wouldn’t be able to “beat the market,” according to Medicaid director Andy Allison; if more than 200,000 low-income Arkansans gain coverage, Allison argues, the reimbursement rates necessary to entice enough providers to cover that huge new pool of people will be the same whether they’re coming from a public program or private carriers. As Allison put it back in March: “If it’s the same number either way then this question of cost comparability — cost effectiveness — for the private option versus some kind of traditional Medicaid is moot.” I’ll pause here to note that it’s probably a good thing that the feds are the ones with the final say on a budget neutrality test since by the DHS theory, it’s already baked in the cake. If you want to know what traditional Medicaid expansion would have cost, the answer is the cost of the “private option.” Game, set, match! Presumably CMS will settle on a more rigorous means of testing the DHS theory, which has thus far largely been met with skepticism by healthcare watchers outside of Arkansas. Perhaps CMS will compare Arkansas to another state, one that went with traditional Medicaid expansion. But here’s the thing: The demonstration is supposed to determine which costs more: a policy that happens — the “private option” — or an alternative policy, traditional Medicaid expansion in Arkansas, that never happens. That’s an inherently abstract question and the feds are likely to grant a good deal of wiggle room in determining the answer. For example, if Arkansas is compared to another state, there are any number of individual differences between states that might be hard to control for. A budget neutrality evaluation won’t necessarily have a clear, black-or-white result. Given that CMS appears to be politically invested in the success of the Arkansas “private option” policy, the state is probably going to be given some latitude on the budget neutrality question, at least over the course of the three-year demonstration period and perhaps beyond that. Joan Alker, a health policy expert at Georgetown University, does a good job in this post of explaining federal rules for “private option”-style premium assistance schemes and concludes that “CMS left some room for fudginess in how they will approach the issue of cost-effectiveness.” Hmmm. Meanwhile, a recent study from the U.S. Government Accountability Office (GAO) found that CMS isn’t exactly a stickler for proving budget neutrality on Medicaid waiver applications, regardless of what the rules say. Will the state actually achieve budget neutrality? Hard to say, and harder to measure than you might think. There are critics that believe the DHS theory doesn’t pass the smell test; they point to the experience of Massachusetts — when it moved to universal coverage, Medicaid remained significantly cheaper than private insurance on  that state’s healthcare exchange. Regardless, the chances of Arkansas missing out on federal approval because of concerns about budget neutrality — or even the chances of failing a budget neutrality test imposed by CMS — strike me as low. A little “fudginess” goes a long way. That’s not to say that the question of budget neutrality is unimportant. After all, it’s federal taxpayers that will be footing the bill! It matters to the state budget too: If Arkansas continues with the “private option” policy, the state will be chipping in eventually (the feds pick up the full tab for the first three years, the length of the proposed demonstration waiver). Of course the point of a demonstration wavier is to try something new. DHS may be right, and the “private option” may turn out to be just as cost effective as Medicaid, or more so — which would be big news in healthcare reform. It’s an empirical question and we’re about to get three years of data. But it’s also a politicized issue, and I expect that folks will still be arguing about the answer three years from now. 
Source: arktimes.com

AR lawmaker: Medicare private option cost could exceed four times projections

The infamous words of Nancy Pelosi haunted me: we needed to pass Obamacare so we could find out what was in it, she said. Now, incredibly, Republicans in Arkansas were making the same plea. I was asked to approve the largest spending increase and expansion of government in the history of the state of Arkansas. This tested me like no other vote I’ve ever cast.
Source: sayanythingblog.com

Arkansas Moving Forward With Plan to Accept Medicaid Expansion

Speaking of Obamacare, it looks like the Arkansas plan to accept its expansion of Medicaid coverage is on track. This is good news coming from a conservative state. I’m agnostic about whether their proposal to privatize delivery is a smart idea—probably not, since it will increase costs, though you never know—but it’s nice to see that it’s going forward one way or the other.
Source: motherjones.com

Arkansas’ Unprecedented Use of Performance Pay to Contain Health

Things still aren’t perfect in the provider community’s eyes — for example, private insurers reimburse hospitals at significantly different rates, making the total cost of care different depending on which hospital a patient is being treated at and who’s paying — but the program is underway. After analyzing historical data, the state and the insurers set the new standards, the feds signed off on the plan, and in October of last year, doctors started to be evaluated on their performance in three episodes: upper respiratory infections, late pregnancies and ADHD. Two more episodes –congestive heart failure and total joint replacement — were added in February.
Source: governing.com

The Arkansas Medicaid Model: What You Need To Know About The ‘Private Option’

A: No. The Department of Health and Human Services has said it will consider “a limited number” of Arkansas-style plans in which Medicaid beneficiaries would use federal dollars to buy private policies.  Arkansas must give HHS a detailed proposal.  A federal green light is no sure thing, given the plan’s departure from traditional practice and a requirement that it be cost effective. “We haven’t approved anything,” Marilyn Tavenner, acting administrator of HHS’s Centers for Medicare and Medicaid Services, said at a confirmation hearing in April.
Source: kaiserhealthnews.org

Medicare supplement plans for Arkansas

Medicare is a state funded health insurance plan offered to the person aged above 65 years of age or with some kind of disability. Medicare plans help provide assistance for covering out of pocket expenses that insurers find it very difficult to bear on their own. But there are lots of gaps in the Medicare plans and this can be filled only with a supplemental Medicare plan in Arkansas.
Source: medicarearkansas.com

Should Arkansas Accept the ObamaCare Medicaid Deal?

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

Medicaid v. Private Insurance in Arkansas

[…] The logic behind the proposed changes rests in the different needs of the “three programs” represented within Medicaid. Those covered by acute care Medicaid (45-50 million persons) most of them pregnant women and children, are relatively inexpensive to care for on a per capita basis. Increasingly, such beneficiaries have trouble finding providers who will care for them, due to a double whammy of stigma (it is insurance for persons who are poor) and the fact that it pays providers below what Medicare pays, which is less than what private insurers pay. This has lead to a systematic access problem for some Medicaid beneficiaries who have trouble finding a physician willing to treat them. There is nothing inherently wrong with the structure of Medicaid; we could decide to make it the best payer of care tomorrow, but that of course, is not going to happen. Buying them into private insurance policies will mainstream their care and remove a layer of cost shifting. [emphasis added]Source: samefacts.com […]
Source: samefacts.com

PeonInChief: Medicare Card Fraud

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



J will turn 65 in a few months and, in a rite of passage sort of like high school graduation, he received his Medicare card.  (He has also been receiving Medicare supplement advertising by mail, and now follow-up phone calls.  We expect to receive the ads for durable medical equipment soon, as well.)  But back to the card.  There,  front and slightly-below-center, is his full Social Security number.  The number we’re admonished never to give to anyone.  That one.  The one that identity thieves spend lots of time trying to get.  The one that enables them to get credit cards in your name and make purchases you would make if you could afford them.
Source: blogspot.com

Video: Medicare Card Fraud: Protect Your Identity

Ohio Elder Law and Estate Planning: Guard Your Card To Stop Medicare Fraud

News and Discussion on Ohio Elder Law and Estate Planning, including Medicaid and VA Aid and Attendance, Wills, Living Trusts, Guardianship, Healthcare Powers of Attorney, Living Wills, HIPAA, Probate, and more by Columbus, Ohio Estate Planning Lawyer Russell C. Golowin. For more, visit OhioSeniorLaw.com
Source: blogspot.com

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for millions of Medicare beneficiaries begins Oct. 15. In that time, seniors can shop for a private health plan known as Medicare Advantage, pick a drug insurance policy or buy a supplemental Medigap plan. And in nearly two dozen states, some Medicare beneficiaries who also qualify for Medicaid may be choosing private managed care plans. None of these four kinds of coverage will be offered in the health law’s marketplaces.
Source: kaiserhealthnews.org

Barbara Barth “Sparkle”: Holy Crap, I Just Got My Medicare Card or Sparkle At Sixty

The day my card arrived (last week) I looked in the mirror to see if I’d changed overnight. A long critical moment proved what I needed to know. I was exactly the same gal I was the day before, the month before, and actually all the last year, and maybe even a year or two before that! My daily routine of slathering my face with ROC at night paid off, I didn’t see any more wrinkles. My lip-gloss shimmered and made my smile and teeth look good (all mine pu-lease, what were you thinking?).  My short hair (which I cut myself and have for twenty years) had that bedroom look I love. I still needed to lose weight. I was still ME!
Source: blogspot.com

July 30, 1965 ~ Former President Harry S. Truman receives the first Medicare card

On this day July 30, 1965 President Lyndon B. Johnson signed the Medicare bill into law. Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. In 1972, Congress expanded Medicare eligibility to younger people who have permanent disabilities and receive Social Security Disability Insurance (SSDI) payments.
Source: richardhowe.com

How to Protect Yourself from Medicare Fraud

In rare cases, Social Security representatives may call Medicare beneficiaries if they need more information to process applications for Extra Help with Medicare prescription drug costs. If a phone call is needed, you will receive an official letter to arrange a phone interview, and you should be asked to confirm the date of your telephone interview by returning an acknowledgement form to Social Security.
Source: ehealthmedicare.com

New Medicare card scam targeting senior citizens

Scams targeting older adults are endless, primarily because they keep working.  The newest version of an ongoing scam is one where an “official” with Medicare is calling because Medicare is sending out new cards and he needs to verify some information.  Of course the information he is looking for is your banking information.
Source: fortbendstar.com

Code Key for Medicare Card Explained

A: Social Security pays benefits to some 56 million people. They include retirees, widows and widowers, families who’ve lost their breadwinners, divorced spouses and people with disabilities. In order to keep track of such huge numbers, Social Security uses a series of codes to identify which individuals are receiving what types of benefits. The codes are assigned to people when they apply for benefits.
Source: aarp.org

Another Jindal Swindle in trouble: SELH, aka Northlake, loses Medicare eligibility nine months after privatization

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



AFSCME Alliance for School Choice American Federation of State Anarchy Ann Williamson Attorney General Bechtol Russell Black Bear Bob Levy Bonding Assistance Program Business Report Chafee Educational Training Voucher Charters Charter Schools College Students Commandeer County and Municipal Employees Digital Medial Incentive Early Start Program Enterprise Zone FastStart Financial Literacy for You Francis Thompson Frank Simoneaux Go Grant Governor Hebert Heresy Huey Long Industrial Tax Exemption Jim Champagne Jindal John Schroder John White Kyle Plotkin Live Performance Tax Credit Louisiana FastStart Louisiana Guaranteed Student Loans Louisiana State Troopers Association Michael Walker-Jones Micro Loan Program Mike Thompson Modernization Tax Credit Morgan-Keegan Motion Picture Investor Tax Credit Office of Group Benefits Per Capita Income Poverty Professional Fire Fighters Association Quality Jobs Rainy Day Fund Rene Greer Rep. Alan Seabaugh Rep. Bob Hensgens Research and Development Restoration Tax Abatement Rockefeller State Wildlife Scholarship Sibille Small Business Loan Program Sound Recording Investor Tax Credit Spending Freeze START State Matching Funds Grant State Revenue Steve Monaghan Tax Credit Tax Cuts Technology Commercialization Credit and Jobs Program Teepell TOPS Veteran Initiative and Mentor-Protege Tax Credit Veto Violent Crime Vouchers Weitz Golf International
Source: louisianavoice.com

Video: Louisiana SMP (Senior Medicare Patrol) revised

MedicareBob’s Blog: Caddo County Louisiana Medicare Supplement Quotes

                                        1-800-525-0299. ____________________________________________
Source: blogspot.com

Operators of Louisiana Home Health Company Sentenced in $17.1 Million Health Care Fraud Scheme

WASHINGTON—The owner of South Louisiana Home Health Care Inc. and the director of nursing for the Louisiana home health agency were sentenced today for their roles in a Medicare fraud scheme involving the payment of kickbacks and the falsification of documents. Acting Assistant Attorney General Mythili Raman of the Criminal Division; Acting United States Attorney Walt Green of the Middle District of Louisiana; Special Agent in Charge Mike Fields of the Dallas Region of the HHS Office of the Inspector General (HHS-OIG); Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division; and Louisiana State Attorney General James Buddy Caldwell made the announcement. Louis T Age Jr, 64, owned and operated South Louisiana Home Health Care and operated this company along with his former wife, Verna Age, 60, who served as the company’s director of nursing. Louis Age and Verna Age, both of Slidell, Louisiana, were sentenced today by United States District Judge James J Brady of the Middle District of Louisiana to 180 months and 60 months in prison, respectively, and ordered to forfeit $9.2 million and pay $17.1 in restitution. After a jury trial in March 2013, Louis Age and Verna Age each were convicted of one count of conspiracy to commit health care fraud, and Louis Age also was convicted of one count of conspiracy to defraud the United States and to pay or receive illegal health care kickbacks. Verna Age previously was convicted of one count of conspiracy to defraud the United States and to pay or receive illegal health care kickbacks after a jury trial in October 2012. According to evidence presented at trial, Louis Age and Verna Age paid kickbacks to patient recruiters to obtain Medicare beneficiary information. Nurses, including registered nurse Verna Age, then falsified qualification documents to make it appear that these beneficiaries qualified for home health services. The evidence also showed that Louis Age hired and paid kickbacks to medical doctors to sign fraudulent referrals and certifications for home health services that were not medically necessary. Louis Age and Verna Age then used the Medicare beneficiary information and false documents to bill Medicare for the medically unnecessary home health services. From 2005 through 2011, Medicare paid South Louisiana Home Health Care approximately $17.1 million based on these fraudulent home health care claims. This case was investigated by the FBI, HHS-OIG and Medicaid Fraud Control Unit of the Louisiana State Attorney General’s Office and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Middle District of Louisiana. The case was prosecuted by Trial Attorneys David M Maria and Abigail B Taylor of the Fraud Section, with assistance from Trial Attorney Arunabha Bhoumik. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov. Reported by: FBI
Source: 7thspace.com

East Baton Rouge County Louisiana Medicare Supplement Quotes

Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Best Supplement, Cheapest Premium, Cigna Supplement, East Baton Rouge County, East Baton Rouge County Cheapest Medicare supplement rates, East Baton Rouge County cost effective Medicare supplement rates, East Baton Rouge County Louisiana Medicare Supplement Quotes, East Baton Rouge County Medicare, East Baton Rouge County Medicare Supplements, East Baton Rouge Louisiana supplement quotes, East Baton Rouge Medicare Agent, East Baton Rouge Medicare Supplement Quotes, Louisiana Medicare, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, United Healthcare Supplement, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud: The New Health Care Law Reform Bill & PPACA

Enforcement efforts have also reached Michigan, where the government recently announced a $4 million settlement of a health fraud lawsuit filed under the False Claims Act. The qui tam lawsuit (a lawsuit brought by a private citizen, popularly called a "whistle blower," against a person or company who is believed to have defrauded the government) was filed by Ann Arbor cardiologist Dr. Julie Kovach against Jackson Cardiology Associates, its owner, cardiologist Jashu Patel, and Allegiance Health hospital, all located in Jackson, Michigan. The lawsuit alleged that Patel and other cardiologists performed unnecessary catheterizations on patients based on nuclear stress tests that were improperly read as positive. These catheterizations were invasive procedures that involved snaking a tube into the heart through an incision in the patient’s groin. According to the complaint, three fourths of these patients had no significant heart blockages and therefore did not need the procedure.
Source: healthlawyersblog.com

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

MRA Alerts and Updates: La. ranks #1 in recovered Medicaid fraud money

The Department of Health and Hospitals released details in a news release on Tuesday. DHH says the state Medicaid fraud unit recovered more than $124 million during the past fiscal year, according to the Centers for Medicare and Medicaid Services.
Source: blogspot.com

Welcome to Medicare Information Sessions

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



Need help understanding Medicare? The Welcome to Medicare Class is for current Medicare beneficiaries, those soon to be eligible for Medicare or anyone who wants to learn more about Medicare health coverage. We will cover the various options, prescription drug coverage, supplements, and benefits. Materials will be provided. The class is free and will be taught by a SHIBA (Statewide Health Insurance Benefits Advisors) volunteer/trainer. The SHIBA program provides free, unbiased, and confidential assistance with Medicare and other health care choices.
Source: ctc.edu

Video: Introduction to Medicare – Sources and Use of Medicare Enrollment Information

Report: Medicare Surges Ahead in ACO Growth

The report, “Growth and Dispersion of Accountable Care Organizations: August 2013 Update," details how the growth and proliferation of accountable care initiatives has unabatedly continued over the last twelve months. The broad adoption of accountable care paired with the emergence of preliminary results has provided some clarity to the overall accountable care movement, it says.
Source: healthcare-informatics.com

McKay’s Mill Medicare Information Sessions

Hosted by McKay’s Mill residents / Senior Benefits Counselors Susan Skinner and Kelly Napier, these sessions will help seniors understand the important features and costs to consider when enrolling in Medicare.  Other available topics of discussion may include Social Security, Medicaid, and VA benefits.  No products or policies will be sold—these are information-only sessions.  If unable to attend one of these sessions, or for additional information, please feel free to contact us.
Source: mckaysmillhoa.com

Webinar: Medicare for Medicaid Advocates: As Easy as A, B, C (and D)

Medicaid advocates whose clients include dual eligibles and low income older adults need a working knowledge of the Medicare program to be able to serve their clients. Join NSCLC for a webinar that presents the basics of Medicare with particular emphasis on how the program works for low income individuals, including those qualifying for Medicaid. In this webinar, learn:
Source: nsclc.org

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

Illegal Marketer of Medicare Information Admits Role in Detroit

According to court documents, Cooper and others conspired to defraud Medicare through purported home health care companies operating in the Detroit area, including now-defunct First Choice Home Health Care Services Inc. and Reliance Home Care, LLC. Cooper admitted that he sold Medicare information he obtained from Detroit-area Medicare beneficiaries to other conspirators at these and other health care companies, knowing that it was to be used to submit claims to Medicare for home health services that were not medically necessary and/or not provided. According to court documents, from 2008 through May 2012, Cooper sold co-conspirators the Medicare information of hundreds of Medicare beneficiaries, at $200 to $300 per beneficiary, and this Medicare information was used at these companies to bill Medicare for nearly $1 million in home health care services.
Source: phiprivacy.net

Information for PWD's on Medicare

There is little question that this new system will be better in the long run.  The government will save money and you will see your co-pay and deductible amounts decrease.  For example, patients testing one time a day, before July 1, have an average co-pay of approximately $14.47 on their testing supplies.  After July 1, for the same order, the co-pay will decrease to approximately $4.49. This is a savings to you of almost 70%!  The actual cost may be even lower or no cost at all if you have secondary insurance.
Source: scottsdiabetes.com

Possible Medicare Scam Calls in Staunton

A VICAP client in Staunton called the main Valley Program for Aging Services office this morning to express concerns over multiple phone calls she has been receiving from a Florida number. The caller has a strong foreign accent and called at least three times in one day claiming to be from Medicare, asking for personal identifying information and saying the information is needed so a new Medicare card can be sent out.
Source: stauntonseniorcenter.org

Comments Off  :  Add Comment
August 29, 2013

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

Video: Boston: Medicare Fraud Summit Providers Panel

More definitive report confirming that most physicians accept Medicare

Approximately 90% of all office-based physicians report accepting new Medicare patients. The percentage of physicians who report accepting new Medicare patients is similar to the percentage of physicians who report accepting new privately insured patients. In addition, the share accepting new Medicare patients has been relatively stable over the 2005-2012 period and shows a slight increase in 2011-2012 based on initial NAMCS data.  Beneficiary reports of access to care, including the ability to find a physician and see a doctor in a timely manner, are also favorable. Again, these results are comparable to reports by patients with private insurance and have been stable over time. Overall, Medicare beneficiary access to care has been consistently high over the last decade and continues to be high today.
Source: pnhp.org

GAO report calls for more consistency investigating Medicare post

A new Government Accountability Office report says the number of different rules and procedures for Zone Program Integrity Contractors, Medicare Administrative Contractors, Recovery Audit Contractors and Comprehensive Error Rate Testing Contractors is confusing to healthcare providers. For example, providers have 30 days to respond to an Additional Documentation Request (ADR) sent by a ZPIC; 45 days to respond to an ADR sent by a MAC or RA; and 75 days to respond to an ADR sent by the CERT contractor, according to the report.
Source: mcknights.com

GAO: Make Medicare Contractor Requirements More Consistent

These differing requirements potentially reduce efficiency and effectiveness, and they increase the administrative burden placed on providers being audited, according to the GAO. The GAO recommends CMS examine its claims review requirements for contractors and determine how to make them more consistent. CMS should then announce its findings and its plan for taking action. The agency should work to eliminate differences in a way that doesn’t interfere with improper payment reduction efforts, according to the GAO. CMS has begun examining the requirements, according to the report.
Source: beckershospitalreview.com

Bill would exclude Medicare providers involved with fraudulent entities

"The Strengthening Medicare Anti-Fraud Measures Act of 2013," a bipartisan bill that would allow the U.S. Department of Health and Human Services to exclude Medicare providers previously involved in fraud, has been reintroduced in the House of Representatives.The legislation would close a "senseless loophole" by banning executives whose companies have been convicted of Medicare fraud to then switch to another company, as well as banning corporations from using shell companies to engage in fraudulent activities, according to an announcement from the Committee on Ways and Means Subcommittee. "As we continue to find ways to reduce fraud, waste, and abuse within the Medicare program, this legislation takes a common-sense approach by giving the Inspector General another tool to root out fraudsters, said Committee Chair Kevin Brady (R-Texas) and ranking member Jim McDermott (D-Wash) who introduced the bill. Announcement
Source: fiercehealthcare.com

Comments Off  :  Add Comment
August 29, 2013

Programs that help seniors with health care costs

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



To help you find out if you’re eligible for these programs, use the National Council on Aging Web-based tool at benefitscheckup.org. You’ll need to fill out an online questionnaire that asks things like your date of birth, ZIP code, expenses, income, assets and a few other things. Once completed you’ll get a report detailing which programs you may qualify for, along with downloadable application forms and, in the case of Extra Help, allow you to complete your entire application online. The program even knows the specific MSP eligibility rules in your state.
Source: pomeradonews.com

Video: Medicare Shared Savings Program Overview National Provider Call 12/7/11

CMS expands Medicare savings program for durable medical equipment

Blum emphasized that the price cuts had not resulted in any adverse health indicators, such as lack of access, downgraded quality of care, or an increase in hospital admissions in the areas where the agency tested competitive bidding. “No one has challenged the data. It has given us tremendous confidence,” he said in a media conference call. By 2016, the program is scheduled to expand to the rest of the country.
Source: medcitynews.com

Truven Builds Accountable Care Organization For Medicare Shared Savings Program Recipients

“MSSP participants’ HIT infrastructure, analytics capabilities, operations, and physician engagement all need to align in new ways, essentially changing the fundamental nature of the healthcare business,” said Larry Yuhasz, director at Truven Health Analytics. “We have designed this solution to help get the ACO up and running quickly to meet the requirements of the Affordable Care Act, while also laying a foundation that can grow in functionality as the organization decides to adopt more advanced approaches to population health.”
Source: cbslocal.com

Medicare Savings: Cut Benefits to the Elderly or to Big Pharma's Windfall Profits?

The Ryan plan would change Medicare from a guarantee of health care (with associated premiums, co-payments, and deductibles) to a "premium support" program. In other words, it would be a voucher program – the voucher being a flat payment given to beneficiaries to obtain either Medicare coverage or to buy a private insurance policy. This would increase costs significantly for Americans because annual increases in the amount of this voucher would likely fail to keep pace with the growth in health care costs from year to year. Thus, beneficiaries would have to pay increasingly more out of their own pockets for insurance coverage, either through Medicare or from private insurers.
Source: foreffectivegov.org

Funding Details: The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance

The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance grants provide funding to State Health Insurance Assistance Programs, Area Agencies on Aging, and Aging and Disability Resource Center programs for outreach to eligible Medicare beneficiaries regarding changes to benefits and coverage under the Affordable Care Act.
Source: raconline.org

What is the Medicare Shared Savings Program

Accountable Care Organizations (ACOs) are groups of physicians and other health care providers that have agreed to work together to provide coordinated care to treatment across a variety of settings.  ACOs aim at providing cost efficient care, and any cost savings generated by the ACO is shared between Medicare and the ACO.  It is estimated that ACOs currently care for more than 2 million patients in the US, and 106 new ACOs have joined the Medicare Shared Savings Program since Jan. 2013.
Source: bhmpc.com

Pioneer ACOs Exit the Program : Healthcare Law Blog

CMS indicated that the costs for the Pioneer ACO program beneficiaries grew by 0.3% in 2012, compared with 0.8% for other similar beneficiaries. All thirty-two of the Pioneer ACOs earned incentive payments for reporting quality measures, performing better overall on fifteen clinical quality measures for which comparable fee-for-service data are available. For example, twenty-five Pioneer ACOs generated lower risk-adjusted readmission rates for their aligned beneficiaries than the benchmark rate for all Medicare fee-for-service beneficiaries. Further, the Pioneer ACOs were rated higher by ACO beneficiaries on all four patient experience measures relative to the 2011 Medicare fee-for-service results.
Source: sheppardhealthlaw.com

CMS Announces July 31 Deadline for Medicare Shared Savings Program Applications : Bridging Business & Healthcare

However, CMS has announced a July 31 deadline.  An accountable care organization intending to submit an application must file a Notice of Intent by May 31 and obtain a CMS User ID by June 10.  Failure to meet these deadlines will disqualify an organization from MSSP participation in 2014.  CMS has not yet published the Notice of Intent form or the application packet.    CMS will be hosting a national provider call regarding the 2014 MSSP application process on April 9.  A second call is scheduled for April 23.
Source: pyapc.com

Building a Medicare ACO: Mercy Health Select’s Story

Moving forward, Dr. Frankowski and the rest of the Mercy Health Select team are looking forward to expanding their ACO efforts. “We’re able to take the tools we’re using in the MSSP ACO and apply them to other groups that we’re caring for,” she says. With that in mind, Mercy Health has been developing other programs to implement beyond its MSSP patient population. For instance, one pilot program is a high-touch hospital transition program with nurse care coordinators following a patient for 30 days after discharge to help reduce readmissions further.
Source: beckershospitalreview.com

Medicare Savings Program 2013

Applications for these programs may be obtained from the Medicaid office at the local (county) Department of Social Services. Or, you may print the application form from the link below. All applications for the Medicare Savings Program must be mailed to the local Department of Social Services where you live. The phone number and address for the local Department of Social Services may be found in the government pages of the telephone book.
Source: healthcoverageally.com

Comments Off  :  Add Comment
August 29, 2013

Medicare cost saving measures come at expense of patients

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



If you use a walker, wheelchair or a handful of other select medical equipment, you will likely have to wait longer the next time you place an order. The federal government has been phasing in a competitive bidding program for equipment purchased through Medicare. YNN’s Katie Gibas tells us the effect this has had on patients and businesses in Upstate.
Source: ynn.com

Video: What Does Medicare Cost?

Medicare Spending: Causes of Slower Growth in Medicare Fee for Service

Medicare was not the only place where health costs fell. The CBO also recently reduced its budget projection for Medicaid by 5.6 percent. The Kaiser Family Foundation reported relatively slow growth for employer-sponsored insurance (ESI) average premiums in 2012 – 4 percent for family health coverage. USA Today reported health spending as a share of the economy shrank to 17.04 percent last year, compared to 17.12 percent in the year before. To round out the good news, the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) found that national health expenditures grew 3.9 percent each year from 2009 to 2011, the lowest level of growth in 50 years.
Source: piperreport.com

Time to consider Medicare choices

The Medicare Part B premiums will increase from $104.90 per month in 2013, but the amount hasn’t yet been announced. The announcement will be made before open enrollment begins. If you earn more than $85,000 for a single person or $170,000 for married people filing jointly, you’ll pay additional premiums based on your income. Part D premiums also are subject to these sliding scales. These income levels haven’t increased since 2010, so more people will face these income penalties.
Source: bankrate.com

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

Pioneer ACO Results Include Improved Quality, Lowered Medicare Costs

Detroit Free Press: U-M System Pulls Out of ACO Health Care Program Patient health may have improved within the nation’s 32 Pioneer Accountable Care Organization (ACO) programs, but the results were mixed after the first full year, the U.S. Centers for Medicare & Medicaid Services (CMS) said Tuesday. And one of the three Pioneer ACOs in Michigan — the University of Michigan Health System — is withdrawing from the program designed to test a tenet of federal health care reform: that coordinated care keeps chronic conditions under control and drives down costly trips to the hospital (Erb, 7/16).
Source: kaiserhealthnews.org

Redesigning Medicare cost sharing

Supporters of redesign believe that cost sharing under a redesigned Medicare program will be more predictable and simpler for beneficiaries to understand and better align incentives to reduce any overuse of services. Others fear that, if designed to reduce federal spending, restructuring the benefit design would likely shift costs onto many Medicare beneficiaries. Critics note that Medicare beneficiaries already spend three times as much of their income on health care as do people under age 65. Critics believe most beneficiaries cannot afford to pay more for their health care and are particularly concerned about proposals that include even higher deductibles or out-of-pocket caps.
Source: pnhp.org

Medicare Benefits and Cost

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

2013 Cost Projections for Medicare Programs

This week’s charts compare the Medicare cost projections under current law assumption with more realistic alternative assumptions measured as a percentage of the economy. The Medicare Trustees’ Report presents an illustrative alternative scenario that assumes a continuation of the historical pattern of SGR overrides; the report also shows an another alternative scenario in which, in addition to an SGR override, certain controversial elements of the 2010 Affordable Care Act (ACA) are either scaled back during the period from 2020 to 2034 or eliminated altogether.
Source: mercatus.org

Comments Off  :  Add Comment
August 29, 2013

Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



The study also examines the expected impact of two variations of this proposal. The first looks at a higher or lower out-of-pocket spending limit, and illustrates how raising the limit would increase beneficiary costs while reducing Medicare spending, while a lower limit would do just the opposite. The second variation examines the effect of combining the alternative benefit design with restrictions on Medigap coverage, another frequently mentioned approach to achieving Medicare savings.
Source: kff.org

Video: Improving Medicare in 2011

2013 Employer Health Benefits Survey

Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.
Source: kff.org

Medicare Determination Of Benefits

Since 2006, everyone who receives Medicare can also get prescription drug coverage, known as Part D. This premium paid service is provided through private enterprise. If you do not sign up for this benefit when you become eligible for Medicare, you may incur a penalty when you sign up in the future. Beginning in fall 2010, those who pay for this feature and find themselves in the so-called “doughnut hole” will receive a one-time $250 rebate. The doughnut hole is when expenses exceed payments through Medicare, and you must pay bills using out-of-pocket money. In 2011, participants will get a 50 percent discount when purchasing covered medications.
Source: blogspot.com

Breitenfeldt Group: Offering simple Medicare solutions

Some of the things to consider include premium costs, benefits, provider choice, prescription drugs, pharmacy choice, convenience, travel and quality of care. What will you pay out of pocket? Are extra benefits available, like eye  exams or hearing aids? Does your doctor accept the plan? Do you spend a part of each year in another state? What will your prescription drugs cost? What pharmacy can you use? Do you have or are you eligible for other types of coverage? Do you qualify for extra help? These are some of the questions that will be answered as your Medicare “puzzle” is assembled.
Source: srperspective.com

More definitive report confirming that most physicians accept Medicare

Approximately 90% of all office-based physicians report accepting new Medicare patients. The percentage of physicians who report accepting new Medicare patients is similar to the percentage of physicians who report accepting new privately insured patients. In addition, the share accepting new Medicare patients has been relatively stable over the 2005-2012 period and shows a slight increase in 2011-2012 based on initial NAMCS data.  Beneficiary reports of access to care, including the ability to find a physician and see a doctor in a timely manner, are also favorable. Again, these results are comparable to reports by patients with private insurance and have been stable over time. Overall, Medicare beneficiary access to care has been consistently high over the last decade and continues to be high today.
Source: pnhp.org

Is Medicare a Ponzi Scheme?

The American Magazine

Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.
Source: american.com

Obama Does Want to Cut Medicare and Social Security Benefits

Obama put cuts to these programs on the table because he wants to sign a package with cuts to these programs. His stated goal is a large deficit reduction package that is mostly spend cuts with very few tax increases. The only way he can get that without making major cuts to the Pentagon is by cutting the social safety net. If Obama actually wanted an equally large deficit reductions package that was mostly tax increases, he could easily already gotten that by vetoing any extension of the Bush tax cuts. He only wants to reduce the deficit if it is mostly through cuts.
Source: firedoglake.com

New Medicare Benefits and Changes for 2011

Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Source: aarp.org

Democrats on Super Committee Offer to Cut Medicare Benefits

It is unlikely this specific deal being offered by the Democrats on the committee will be accepted by Republicans, because it calls for tax increases and more stimulus, but it still puts our social safety net in danger. It is another instance of the Democratic party steadily moving towards the official position of saying Medicare benefits can and should be cut.
Source: firedoglake.com

Medicare Drug Benefit: Model for Broader Health Care Reform

The “rebate”—which really amounts to government price controls—would change everything. Today, pricing is determined entirely by a negotiation between private insurers and drug manufacturers focused on the value of prescription drug products for the patients. With rebates, the government would get involved in the conversation, and that spells trouble. Drug manufacturers would seek to use the rebate requirement to extract higher pricing from the insurers, even as they lobbied the government to base the rebates on the most inflated measure of “average” price they could find. In time, as in other parts of Medicare, the government’s price-setting reach would expand further and further based on new legislative proposals and the natural tendency of bureaucracies to seek to control more and more decisions. Eventually, the private plans now participating in Part D would lose their ability to determine their own fates, which would spell doom for the current program.
Source: heritage.org

Comments Off  :  Add Comment
August 29, 2013

Medicare Website Receives Top Marks

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
Source: kp.org

Video: Finding Medicare C and D plans on Medicares Website

Medicare’s Physician Compare Website: 10 Things to Know

2. In 2014, the website will include quality of care ratings for group practices, with ratings for individuals to be added in the future. There is a 30 day period for groups to review data before being posted online, according to an AMA report.
Source: beckersasc.com

Doctor Ratings Data Added to CMS Physicians Compare Website, Medicare

The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic information about doctors and group practices, such as their addresses, specialties and clinical training.
Source: aarp.org

Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality

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

Medicare to Keep Hospital Mistake Data On Website

What is changing, he explains, is that some of these measures will no longer be part of the Inpatient Quality Reporting program, for which hospitals have received a 2% market basket pay increase in exchange for reporting the data. CMS will still get the data, but the hospitals won’t get paid for submitting it. … Just because a measure is not reported to the IQR program, it doesn’t mean that it will be taken off Hospital Compare,” he says. These eight measures, of the 11 hospital-acquired conditions for which Medicare denies hospitals reimbursement under provisions of the 2005 Deficit Reduction Act (DRA), and which are now posted on Hospital Compare, “will continue to be displayed and available in the downloadable database after July, 2013.”
Source: reportingonhealth.org

Medicare Parts A, B, C, D

-Medicare Part B covers Medically Necessary Services used to treat or diagnosis an illness (Includes things such as Clinical Research, Ambulance Services, DME (Durable Medical Equipment), Mental Health, Second Opinions before Surgery, and Outpatient Drugs) or to prevent an illness.
Source: stratasan.com

Comments Off  :  Add Comment
August 29, 2013

Expand Medicaid to help local governments

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

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

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

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

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



The ACA is lowering  hospitals’ governmental DSH (Disproportionate Share Hospital) reimbursements for low-income patients by $22 billion over 10 years. However, hospitals were told that these decreases were to be offset by having Medicaid cover patients who were then being served but not paid for (by private insurance, Medicaid or Medicare). When the U.S. Supreme Court ruled that states could opt out of expansion, that offset was no longer assured, but it continues to be a good idea.
Source: georgiahealthnews.com

Video: Georgia Health Insurance Medicare

Georgia expected to spar over Medicaid expansion in election aftermath

The Centers for Medicare and Medicaid Services have told states that the first three years of expansion would be fully funded beginning in 2014, with the rate dropping to 90 percent by 2020. Robinson said that Geor­gia’s share, however, would be $4.5 billion over the next 10 years and that the state doesn’t have the money, nor does the federal government have the other $40 billion it would spend on expanding Georgia Medicaid.
Source: augusta.com

Augusta needs Medicaid expansion, and so does Georgia

This idea that a 2% increase in our budget…and consequently an increase in OUR taxes…..is okay is the kind of thinking that is killing those of us who PAY the taxes. “Oh, it will create jobs” is always the answer but somehow it never does, and the welfare, SSI, food stamp, and Medicaid rolls keep growing because we keep offering them a better deal. Meanwhile the taxPAYERS are stuck with the 2% increase for this, and a 4.9% increase for that, and a sales tax increase for the roads, and, if you actually PAY you medical bills a 3% increase on your medical devices. This line of thinking that federal or state budget increases, more taxes, and more spending on give away programs are somehow good for the economy….good for the taxpayer…..is simply crap. Everyone, even the Democrats and the CBO, are already admitting that Obamacare is a BUST at controlling or lowering the cost of medical care. They already know that the federal government is not going to be able to afford even the 90% that they promised and many of the states know that they cannot afford the 10% and that the feds will most likely figure out how to get out of paying their 90%.
Source: augusta.com

Georgia offering Medicare info

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Posts and comments do not reflect the views of this site. Posts and comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the “Flag as offensive” link below the comment.
Source: augusta.com

Deal again says Georgia can’t afford Medicaid expansion

Members of the Georgia Chamber, Lieutenant Governor Cagle, Speaker Ralston, state legislators, elected officials, judges, justices, ladies and gentlemen: Let me begin by congratulating you. We have had one of the best years of economic development in quite some time. A few notable companies that have chosen Georgia include Baxter, General Motors, and Caterpillar, along with numerous others. We did this with your help, with both the private and the public sector doing their parts! Several weeks ago, the lieutenant governor, along with Sandra and I hosted a reception at the Governor’s Mansion to honor Georgia’s Olympic and Paralympic athletes who competed at the London Olympic Games. This was an outstanding group of young people of whom we are extremely proud. One of the men in the group was Aries Merritt, a native of Atlanta and a graduate of Wheeler High School in Marietta. Aries won an Olympic Gold Medal in the 110 meter hurdles. Unlike sprinters who travel in a straight line with no obstacles other than the lane markers assigned to them, hurdlers, as the name implies, must jump over obstacles that are placed in their path. Making analogies between sports and government is always risky, but I want to suggest to you that the business of governing our state is somewhat similar to running the hurdles. As governor, my goal is to see Georgia become the No. 1 state in the nation in which to do business. I have made that clear from the beginning, because I believe that is the best path to economic growth and the quickest way to get Georgians into jobs. And we are not all that far off from reaching our target: For two years in a row, we have ranked in the top five for business climate by Site Selection Magazine, and we ranked No. 3 for doing business in 2012 by Area Development Magazine. But we certainly still have some hurdles that we must overcome before we get there. This morning I will focus my remarks on one of the highest hurdles facing state government, that of healthcare. In Georgia, we have had many successes in the realm of healthcare. With rising healthcare costs, we have worked to keep Georgians healthy so that they can avoid some of these expenses rather than react to them when they become ill. We have launched the Georgia SHAPE program as a way to combat childhood obesity, a growing problem in our state. I proclaimed this past September “Georgia SHAPE Month,” during which we emphasized physical activity and proper nutrition for our state’s children. In its inaugural year, the Governor’s SHAPE Honor Roll had 39 schools achieve Gold Medal status for their dedicated work in making our state’s youth healthier. These healthier young people generally perform better in the classroom, and many will continue their healthy lifestyles into later years, making these programs an investment in the economic and cultural well being of our state. The State Health Benefit Plan just finished the first year of its Wellness Program – the largest such program in the country, with more than 245,000 enrollees. We would like to take the next step by growing and developing it; we want to see employees taking responsibility for their own health through preventative action … and receiving lower premiums as a reward. Even with all of these cost-saving approaches, it still costs approximately $10 million per day in claims to provide health benefits to active and retired employees and teachers. Those costs have and will increase because of Obamacare’s mandated benefits; in FY2014, the State Health Benefit Plan is projected to incur $106M of additional costs due to Obamacare. And because our State Health Benefit Plan is classified as a Self-Insured Plan, it is subject to the three-year Obamacare reinsurance tax. This means we would pay an additional $35M in 2015. Of course, even among the healthy, not all illness can be prevented; so last year, we grew graduate medical education by adding funding in the budget for the development of 400 new residency slots in hospitals throughout the state, helping keep Georgia’s doctors in Georgia. These are just a few of the great things we have going for us in healthcare. But we also face hurdles that we must overcome, like how to fund the state’s responsibility for Medicaid. Right now, the federal government pays a little under 66 cents for every dollar of Medicaid expenditure, leaving the state with the remaining 34 cents per dollar, which in 2012 amounted to $2.5B as the state share. For the past three years, hospitals have been contributing their part to help generate funds to pay for medical costs of the Medicaid program. Every dollar they have given has essentially resulted in two additional dollars from the federal government that in part can be used to increase Medicaid payments to the hospitals. But the time has come to determine whether they will continue their contribution through the provider fee. I have been informed that 10 to 14 hospitals will be faced with possible closure if the provider fee does not continue. These are hospitals that serve a large number of Medicaid patients. I propose giving the Department of Community Health board authority over the hospital provider fee, with the stipulation that reauthorization be required every four years by legislation. They have experience in this area, having had authority over a similar fee for the nursing home industry since around 2004. Of course, these fees are not new. In fact, we are one of 47 states that have either a nursing home or hospital provider fee – or both. It makes sense to me that, in Georgia, given the similarity of these two fees, we should house the authority and management of both of them under one roof for maximum efficiency and effectiveness. Sometimes it feels like when we have nearly conquered all of our hurdles, the federal government begins to place even more hurdles in our path. I am, of course, referring to the various mandates of Obamacare that put a strain on our state, its businesses and its citizens. As most of you are well aware, the United States Supreme Court upheld the individual mandate as a tax. Therefore, most Georgians, beginning in 2014, will be forced to get insurance coverage or else pay a minimum of $95 (and potentially far more) in penalties. So what does this mean for us? It means that Georgians must pay out dollars to either an insurance company or the federal government – whether they want to or not. But ultimately there still is a choice, albeit a rock-and-a-hard-place kind of choice. As more individuals enter the marketplace, younger, healthier Georgians might begin deciding they would rather pay the penalty than deal with the potentially much higher cost of coverage, causing the price of insurance for everyone to climb; this increase will drive even more healthy individuals out of the market, further swelling the cost. This potential cycle is one of the inherent flaws in the federal law. The employer mandate means that businesses with 50 or more employees must provide affordable health insurance to their workers or else pay the rather large penalties. Costs can increase here, as well, as the pool of insured becomes less healthy. These costs stand to hurt our state’s private sector. Because as all businessmen and women know, the higher your input costs, the lower your profits; the lower your profits, the less you operate, expand or employ. But whether it’s through fewer employees and less equipment purchases or higher costs, this mandate will negatively impact many of our state’s businesses and, of course, the would-be employees themselves. Georgians who have already received a paycheck this January have no doubt noticed that their payroll taxes went up and their take-home salary went down. This is the cost of entitlements. If you think your taxes went up a lot this month, just wait till we have to pay for “free health care.” Free never cost so much. The individual mandate has a second tier of impact involving Medicaid and its cost to the state. I have said clearly that Georgia will not expand Medicaid under the federal government’s guidelines. Even so, in Fiscal Years 2013 and 2014, Medicaid and SCHIP funding will be the second largest portion of the state funds budget with more than 13 cents of every dollar going straight to one of these programs. And with just the portions that our state must do, Obamacare is expected to add more than 100,000 new individuals to our Medicaid rolls and mandate other requirements, costing our state nearly $1.7B over the course of 10 years – and that’s on top of the $2.5 B we already pay annually. The reason: These Georgians qualify for Medicaid under the current system but have yet to enroll in it. With the individual mandate requiring either insurance or a hefty fee, they will likely think that Medicaid looks like a pretty good option. And since they fall under the current system, the state of Georgia and its taxpayers must pay the current rate of 34% and not the 0 to 10% rate proposed for the expanded population group. We constitutionally must balance our state budget – a wise requirement instituted by those who have come before us. This increase in costs to the state means we have to find that money somewhere in our already tight budget; we cannot simply create more. As such, I have instructed the Department of Community Health to reduce its budget by at least three percent in Amended Fiscal Year 2013 and by five percent in Fiscal Year 2014 – a difficult but necessary task. They have already identified $109M in cost-saving measures between the two years. But this hardly covers the additional nearly $500M in needed funds caused by growth in Medicaid expenses during the same time frame. That means we must make necessary cuts in other agencies and core functions of government since raising taxes is not an option I will accept! As I have indicated, I have rejected the Medicaid expansion in Georgia already, but let me emphasize that the expansion would have put our additional costs over 10 years closer to $4.5B – and that’s operating under the dubious assumption that the federal government, with its ever-growing national debt, would have fulfilled their promised share. The 620,000 new enrollees would have stretched our resources and our state to the limit. But whether the cost to our state would have been $2B, $4B or $6B, it does not make much sense to ask for more hurdles when you are already utilizing every muscle in your state’s body to overcome the ones you currently have before you and that you must face. So unless the federal government changes it to a block-grant program and allows Georgia to design the benefit plan, I cannot justify expanding Medicaid. The irony to me is that there are those in the medical community who are urging the expansion of the Medicaid program while at the same time, we are seeing more and more medical providers refusing to accept Medicaid patients. Their reason for doing so is that they claim the reimbursements for their services are below their costs. It is for that reason that the previously discussed provider fee is so important since that revenue is used to pay providers. If providers are already having difficulty covering their costs for care to Medicaid patients, how will they accommodate 34% more people on the Medicaid rolls? If you are losing money now, how do you reconcile the number of patients on whom you will lose even more money? Add to that the fact that the new enrollees would be higher on the economic scale, and some will be leaving their higher-paying, employer-provided health insurance plans to enter the taxpayer-funded Medicaid program with its lower reimbursements for the providers. If we have to depend on provider fees now to keep our reimbursements to Medicaid providers at a “tolerable” level, just imagine the pressure that will come when hospitals and doctors are losing more money on a larger portion of their patient base. Expansion of the Medicaid rolls does not solve the problem, it only exacerbates the one we already have. As many of you know, I also turned down the federal government’s offer to let us put our name on their insurance exchange program. I have no interest in seeing our state’s name, or its taxpayer dollars, used on something that we would have very little input in designing. If the purpose is to let those closest to and most knowledgeable about the population design the program, then we should be allowed to do so. It does not appear that is the pattern for the exchanges. I see no benefit to our citizens to have a program bearing the name of the State of Georgia over which our elected or appointed officials have little if any say so. While many federal programs come with strings attached, these strings turn states into marionettes to be manipulated by federal bureaucrats. If there is one thing we don’t need, it is another puppet show directed from Washington, D.C.! We cannot always determine what obstacles will be laid in front of us, but we can decide how we deal with them, and whether we approach them with anger, indifference or decisive action. The first two provide very little in productivity, but the latter offers opportunity to grow our state (and our businesses) in spite of newfound hurdles. Therefore, we must choose to work diligently. We must choose discernment over acquiescence, which is what I have aimed to do in my decision-making. And we must choose to confront these hurdles together, because discussion and determination, without bitterness, lead to the greatest forward progress. Despite all that is in front of us, we will still make Georgia the No. 1 state in which to do business. One last note: For those of you not attending in person, tune in tomorrow at 11 a.m. as I outline the rest of my plan for Georgia in this year’s State of the State Address, or go to my Twitter account, where my staff will be live Tweeting my remarks or at least the good parts.
Source: clatl.com

Georgia’s New “Limited Medical” Law Shifts Costs to Medicare

After July 1, 2013, the amended Georgia Workers’ Compensation Act reducing the Employer/Insurer’s overall medical exposure insidiously shifts the responsibility (after 400 weeks) to Medicare in certain cases.   Prior to July 1, 2013, the WCMSA would be forced to contemplate future medical expenses for the life of the injured workers.  Now, the WCMSA analysis simply stops after 7.5 years of treatment from the date of accident in non-catastrophically designated claims.  Consequently, if the injured worker is a Medicare beneficiary, or there is a reasonable expectation he or she will be within 30 months, Medicare will likely bear the cost of the bulk of the injured workers’ future medical treatment.  For example, if an injured worker required a replacement of an artificial knee, this cost would likely be thrust upon Medicare.  This would also include diagnostic scans, films, and medication related to the Georgia work injury.
Source: ramoslawblog.com

Georgia Woman Rewarded For Taking Stand Against Medicare Fraud

While working as a contracts officer at Bard’s Covington office, Darity noticed a pattern of illegal kickbacks being paid by the medical device company to doctors and hospitals that used its products. Over an eight-year-period, according to Darity’s whistleblower lawsuit, Bard inflated the cost of its radioactive seeds used to treat prostate cancer. The hospitals would then charge Medicare the inflated price and Bard would pay kickbacks to the doctors and hospitals from the excess revenue.
Source: personalinjuryattorneycolumbusga.com

Comments Off  :  Add Comment