Medicare, Medicaid cost Connecticut towns money for ambulance calls

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“If the rates go down, then it’s going to depend on the agency. I doubt anybody’s going to show up at a house and not take somebody to the hospital because they have Medicare, but if you can’t afford to operate anymore because you’re taking a big loss on all your transports, it’s not unheard of for first-responder agencies to go bankrupt or curtail services,” he said. “They can try to muddle through, but they won’t have enough money to purchase new equipment or update their apparatuses.”
Source: registercitizen.com

Video: medicare vs medicaid

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

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

Medicare/Medicaid Funding Proposal Would Hurt, Kill Dialysis Patients

There are approximately 20 million persons like us in the USA who have chronic kidney disease (CKD), most commonly the result of diabetes or hypertension. In approximately 400,000 people, the disease progresses to the point where replacement kidney therapy is required. Only a few will receive a kidney transplant because donor organs are scarce, and the rest must undergo dialysis to stay alive. Some patients are capable of dialyzing at home, but the rest must receive treatment three to four times a week in a dialysis center. ESRD most frequently afflicts African American and Hispanic persons, and this therapy is a miracle for them and others with the disease.
Source: thedailybanter.com

Medicaid v. Medicare payment rates

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

Today in labor history: Medicare and Medicaid established

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

Future Medical Treatment and Liens for Personal Injuries Under Medicare v. Medicaid

Medicare can and does claim a lien for Medicare paid medical bills that are related to the personal injury claims. This again includes future medical treatment for those injuries. Medicare’s payment of future bills related to the personal injury serves as the basis for the Medicare set-aside. The set-aside may be a portion or even all of the personal injury proceeds to cover future Medicare payments for medical treatment for the subject injuries.
Source: newmexicoinjuryattorneyblog.com

Uni Care Health Care, United Health Care, Unicare Dental Plan, : UniCare Medicare Prescription Drug Plan Individual Enrollment …

Posted by:  :  Category: Medicare

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Source: projectedu.com

Video: Unicare Medicare HMO Insurance – Compare to 180+ Companies

UniCare MedicareRx Rewards Part D

Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Washington D.C., West Virginia and Wyoming.
Source: affordablemedicareplan.com

News Round Up: UniCare Will Drop Health Coverage For Virginians; Hawaii Concerned About Lack Of Physicians

The Washington Post: “About 3,000 Virginians who have health insurance through UniCare, a private insurer, will lose that coverage Jan. 1, a UniCare spokesman said Monday. Most live in Northern Virginia and get their coverage through the individual market, officials said. The termination will affect only health insurance. UniCare life, dental, vision, disability and Medicare coverage will not be affected” A UniCare spokesman said that “the company is leaving the Virginia market because of competitive pressures” (Sun, 6/29). The Associated Press/Honolulu Star-Advertiser: “Health care leaders from across the state are meeting this week to discuss the worsening shortage of physicians in Hawaii.  … The Hawaii Physician Workforce Assessment concludes that the state has about 20 percent fewer doctors than it should when compared to physician-to-population ratios nationally” (6/28). The Boston Herald, on state Rep. Charles Murphy’s 2009 campaign committee: “Even though he didn’t run for re-election, the Burlington Democrat’s campaign committee brought in $245,710 in donations. … Drug makers had a strong showing. Representatives from Merck, Abbott and Bristol-Myers Squibb all donated. … He is behind an effort to repeal Chapter 111N, the state’s landmark law that bans drug makers and medical device firms from giving doctors gifts worth $50 or more. The controversial law went into effect one year ago, but the real heart of it doesn’t begin beating until later this week.” A spokesman for Murphy said the legislator “made the move after hearing from convention planners and restaurant groups. Both groups told him the state’s decision to prohibit drug companies from treating doctors and their staffs to fancy dinners is hurting business” (McConville, 6/29). The Associated Press/Boston Globe: “Rhode Island health officials are expanding an investigation into the distribution of unauthorized birth-control devices” such as “intrauterine devices in women that were not approved for use by the Food and Drug Administration. Health officials say they can’t vouch for the devices’ effectiveness, but that there’s no urgent need for women to have them removed” (6/28). The Los Angeles Times: “The federal Department of Veterans Affairs has approved $20 million in funding to convert a little-used building at the West Los Angeles VA campus into therapeutic housing for chronically homeless veterans — a plan that has been years in the making. The action was jointly announced Monday by U.S. Sen. Dianne Feinstein (D-Calif.), U.S. Rep. Henry A. Waxman (D-Beverly Hills) and Los Angeles County Supervisor Zev Yaroslavsky. Yaroslavsky said the commitment marked a milestone that ‘has been a long time coming'” (Groves, 6/29).
Source: kaiserhealthnews.org

Unicare to Pull Out of VA

Unicare pulled out of Illinois and Texas on January 1st of this year (2010). All of their customers were transferred over to Blue Cross of Illinois/Texas at the same premium. No complaints from these customers for a few months and then BCBS started increasing the premiums up to what is "normal" for existing BCBS customers. Our telemarketing department is now getting a bunch of leads from these BCBS insureds. An across-the-board increase of 13% is supposed to kick in for all BCBS-IL customers on 8/1/10, just a few days from now.
Source: insurance-forums.net

Unicare Health Insurance Best Health Insurance In California

(866) 690-7108 Business Details Edit info for this business Hours: Not available Categories: Health Insurance (785) 270-1070 Categories: , Insurance UniCare PPO Provider Manual Table of Contents Section 1 Introduction Network Services How to Reach Us UniCare Provider Website Rates. rates are regulated by the Illinois Department of so you can’t find a better price anywhere for the same policy. POLICY QUOTES Medigap Policy. Medicare Supplements. Medicare Supplements and Supplemental Medicare are our top enrolling plans. It is important. Life and Quote provides instant online quotes on low-cost life insurance, health dental, prescription, and travel insurance for. Learn about unicare plans, get free instant rate quotes, compare coverage options with all the major carriers, and apply online. Aetna is a national leader of and related benefits offering health pharmacy, dental, life, products for individuals, medicare and disability. Get an online california medical or quote from many carriers, compare benefits, get an application, see if your doctor is in their network! Instant quotes and benefit comparisons could save you time and money on your premiums. BAA Health Services for Blue Cross of California, Anthem Blue Cross, and California We can find you the right Anthem Blue Cross, Blue.
Source: individualmandatehealthcare.com

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

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

AARP Launches “Commonsense Solutions” Videos About Medicare

Posted by:  :  Category: Medicare

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“As Medicare continues to provide access to health care for millions of seniors and those with disabilities, AARP is celebrating its 48 successful years and advocating for responsible, commonsense solutions that will strengthen the program by lowering drug costs, improving care coordination and cracking down on over-testing, waste and fraud. Nearly 50 million Americans—15 percent of the nation’s population, and growing—depend on Medicare for health security which is why AARP will continue our work to ensure that it is there for current and future generations.
Source: aarp.org

Video: Mississippi Medicare Supplements

Mississippi Political Fight Threatens Medicaid Program, Care For 700,000

Evansville Courier & Press: With Loss Of Funds Projected, Indiana Hospitals Pray For Medicaid Expansion It probably sounded like a good trade-off at the time: Hospitals would give up $155 billion in Medicare and other government payments to help provide more money for a Medicaid coverage expansion that begins in January. But subsequent events have put the deal in doubt in Indiana. Hospitals could be left with nothing to show for the payment reductions, which began with the Affordable Care Act in 2010, if the federal government doesn’t accept Gov. Mike Pence’s idea for administering the Medicaid coverage expansion (Langhorne, 6/22).
Source: kaiserhealthnews.org

Some uninsured may get help without Medicaid expansion

A Mississippi Institutions of Higher Learning economic brief by state economist Bob Neal last year made the nuts-and-bolts of the Medicaid expansion question clear: “The results in each scenario indicate that Medicaid expansion will generate additional state Medicaid costs in years 2017-2025. From 2014-2020, cumulative state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $109 million to $98 million. From 2014-2025, total state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $556 million to $497 million.”
Source: gulflive.com

Singing River health executive Chris Anderson carries Medicaid expansion banner to Mississippi lawmakers

“In 2016, if nothing changes from where we sit today and we don’t expand Medicaid, the reduction will be about $30 million a year in funding,” Anderson said. “But if the state expands Medicaid, we’ll get a portion of that back and we will get better at providing care.”
Source: gulflive.com

JACKSON: BILL MINOR: Wicker may have no use for Medicaid, but his constituents certainly do

Mitchell cited Hancock County Medical Center as a prime example of a small hospital now in danger of having to close unless it gets an injection of funds from the county or additional revenue from Medicaid expansion. Hancock Medical, the lone hospital in the coastal county, is seeking a $6.1 million bond issue from the county board of supervisors. After monstrous Hurricane Katrina plowed into Hancock County in August 2005, the hospital served as a life-saving refuge to render medical care to injured citizens whose homes were devastated by the storm.
Source: sunherald.com

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

Posted by:  :  Category: Medicare

To meet the emergency hospital definition, the hospital must meet certain hours of service, nurse staffing, and state or local licensing requirements. These requirements are “minimal” and should “hopefully apply” to any VA hospital, according to an official who spoke on the Open Door Forum call.
Source: mcknights.com

Video: Medicare Eligibility And Enrollment

Smoking Cessation Coverage for Pregnant Women in Medicaid and Health Insurance Exchanges

The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good example of that by showing that pregnant women in Medicaid with tobacco cessation coverage were less likely to smoke during pregnancy, but only if they had such coverage before becoming pregnant, as childless adults. Since the ACA’s Essential Health Benefits package includes tobacco cessation services, the law could help many more future mothers to quit smoking during or (ideally) before pregnancy.
Source: piperreport.com

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

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

Medicaid Spousal Income Allowance

Because Medicaid is a health insurance program, Medicaid will also permit the husband to deduct the cost of his health insurance premium from his income.  If the husband pays a health insurance premium of $100 per month, then Medicaid will permit a $100 per month deduction to pay his monthly health insurance premium.  In this way, the husband will have Medicare, private health insurance, and Medicaid; Medicaid is the payer of last resort, so Medicaid will only pay for things for which Medicare and the private health insurance do not pay.
Source: eldercarelawyer.com

Faces of Dually Eligible Beneficiaries: Profiles of People with Medicare and Medicaid Coverage

This report illustrates the diverse experiences of dually eligible beneficiaries – low-income seniors and younger adults with disabilities who are eligible for both Medicare and Medicaid – in obtaining medical care and non-medical, supportive services. Based on personal interviews, the profiles of 14 dually eligible beneficiaries residing in California, Florida, Massachusetts, Michigan, and Oklahoma highlight day-to-day experiences with accessing care, maintaining relationships with providers, managing prescription medications and personal finances, and relying on family and friends for additional support. Such personal stories add a human dimension to the ongoing conversations among federal and state policymakers about the importance of high quality, coordinated care for this population.
Source: kff.org

Health insurance marketplaces open Oct. 1

Beginning Oct. 1, people will be able to enroll in a private health insurance plan through a federally run marketplace by going online at HealthCare.gov, by calling 800-318-2596. Customer assistance will be available 24 hours every day. Information can also be obtained from the state Office of the Commissioner of Insurance (OCI) website, oci.wi.gov.
Source: aarp.org

How to Get Retiree Health Insurance Before Medicare Eligibility

In many cases, it may make financial sense to look for an individual insurance plan until you meet Medicare eligibility requirements. If you’d like to keep your premiums low, you might want to consider a high deductible plan. You might have to pay for your own doctor’s visits and initial tests out of pocket, but this type of plan should provide coverage in case you are diagnosed with a serious illness. You can also use a health savings account that works in conjunction with an individual insurance plan to help maximize your savings.
Source: allinsgrp.com

Feds ban some Medicare providers in crackdown

Posted by:  :  Category: Medicare

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

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

Recent Appellate Division Decision Represents Importance of Employee Background Checks : New Jersey Healthcare Blog

which Medicaid reaffirms the absolute obligation on the part of providers to comply with the Medicaid requirements (which are also applicable to Medicare) to perform background checks for all individuals working for a provider who are involved, even peripherally, in providing services that will be paid for by a governmental program.  In this case, the Department of Human Services denied a pharmacy’s application to participate as a provider of services in the Medicaid program.  The applicant (Township Pharmacy) had purchased an existing pharmacy and submitted an application to participate in the Medicaid program to the Department of Human Services.  Question 37 of the Medicaid provider application asked if any officers, directors, shareholders, members, owners, employees or partners had ever been indicted, arrested, charged, convicted, pled guilty or no contest to any federal or state crime.  The pharmacy checked the box marked “No”.  A pharmacy technician who worked at the pharmacy had entered a guilty plea to an Oxycodone possession charge and was sentenced to three years’ probation.  The New Jersey Board of Pharmacy allowed her to keep her pharmacy technician license notwithstanding the entry of the guilty plea.  The pharmacist who purchased the pharmacy allegedly verified that the pharmacy technician was licensed but never performed a criminal background check.  Notwithstanding the fact that the Board of Pharmacy had not taken action against the pharmacy technician’s license, the Department of Human Services denied the provider application based on the pharmacy’s incorrect response to Question 37 regarding criminal history.  The pharmacy conceded that no employee criminal background checks had been performed.  The Appellate Division upheld the denial of the Medicaid provider application.  While the Court noted that it was “sympathetic to the Plaintiff’s predicament”, it concluded that “the integrity of the Medicaid provider program demands scrupulous compliance with the disclosure requirements in N.J.A.C. 10:49-11.1(d)(22).”  The decision serves as a reminder of the importance of performing criminal background checks and verifying that employees are not excluded from participation in Medicare or Medicaid.  Providers who fail to do so, do so at their peril.  In many other situations, when the information becomes available to the Medicaid or Medicare programs, they will recoup the payments that had been made for the services rendered, in which the individual was involved.  The involvement can be very peripheral.  It can be the individual who is sending out the bills who is not permitted to participate in providing the services.
Source: njhealthcareblog.com

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

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

CMS Stops Provider Enrollment With First

Since March of 2011, CMS has revoked the ability of 14,663 providers to bill in the Medicare program. According to a story in Senior Housing News, the agency is now flexing more of its regulatory muscle by enforcing its first-ever moratorium on new provider enrollment in the Medicare program. The moratorium does not affect existing providers and suppliers, who can continue to bill Medicare for services. However, in select areas, no new provider or supplier can begin billing Medicare, Medicaid or the Children’s Health Insurance Program (CHIP) until the moratorium is lifted.
Source: healthcaretechnologyonline.com

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

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

Senators Praise Home Health Moratorium on Medicare Providers

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

Dialysis costs challenge Medicare budget

But at the same time, Swaminathan notes, history teaches that Medicare has encountered costs it could not predict or prevent, and there is no consensus about what level of hemoglobin (a metric of anemia and therefore of treatment performance) is right for ESRD patients. Without clear quality goals, bundled payments could drive providers to under-treat patients and that could create more costs elsewhere in the system.
Source: futurity.org

National Provider Calls: Medicare Shared Savings Program Application Process

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

Medicare Blue Button Smartphone App

Before a patient can download medical information to a computer or a smartphone, the files must first be stored electronically. And while electronic health record advocates note that there has been a sharp increase in the number of hospitals and doctors using EHRs, they acknowledge that a complete electronic system is a long way off. According to a 2012 CDC survey, while 72 percent of office-based physicians are using some sort of electronic system in their practice, only 40 percent of practices meet the definition of a “basic” system.
Source: medbill.net

Medicare Annual Open Enrollment Changes Are Expected, Allsup Explains

Medicare recipients reaching the drug donut hole will benefit from lower costs. The gap in prescription drug coverage starts when someone reaches the initial coverage limit, estimated at $2,850 in 2014. It ends when they have spent $4,550, when catastrophic coverage begins. (These are reductions of $120 and $200, respectively, from 2013.) During the donut hole, all costs are covered by individuals out of their own pocket. In 2014, those who reach the donut hole can receive a 52.5 percent discount on brand-name drugs and 28 percent discount on generic drugs (an increase from 21 percent in 2013).
Source: watchlistnews.com

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

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

How Do I Obtain A Replacement Medicare Card?

Posted by:  :  Category: Medicare

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When ordering a Medicare Card you have a few options. You can do this by internet, the telephone, or you can visit one of your local Social Security Offices. To order a Medicare Card by internet you can visit www.socialsecurity.gov/medicarecard, to complete the application. To order by telephone, the toll free number is 1-800-772-1213. If you prefer to order your card in person, you can call the toll free number to find the nearest Social Security Office or go to www.socialsecurity.gov/locator and type in your zip code to find the location nearest you.
Source: seniorcorps.org

Video: How To Replace A Lost Health Insurance Card.

Get A Duplicate Medicare Card

Medicare is one of the Social Security benefits administered by the Social Security Administration. The program provides low-cost health insurance to people over 65, as well as to people under 65 who are permanently disabled or suffering from kidney failure. Doctors, hospitals and other medical institutions verify Medicare coverage with the Medicare card that includes the beneficiary’s name, Medicare claim number, and the date Medicare coverage became effective. As of 2010, you can replace lost, stolen or damaged Medicare cards online, by phone or in person.
Source: blogspot.com

Obamacare Card Calls are Scams

In a related scam targeting Medicare enrollees, scammers claiming to be “from Medicare” tell consumers that Obamacare requires them to report their personal financial information in order to keep getting benefits. They may even claim that Obamacare is replacing Medicare, which of course, is not true.
Source: about.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

How To Order A Replacement Medicare Card Online

Also if you are getting Medicare or about to, you might want to start getting pro-active on keeping all your benefits. People not receiving Medicare do not want to pay for yours! Yes I know you paid for it. However it is crunch time for money for the government. I think if everyone just agreed to send them $10 more a month they might be okay and not have to fret it so much, but you know that if we all sent them $10, they would soon need 1,000. Our government does not know how to save!
Source: babyboomernewsletter.com

Replacing Your Vital Documents

 – Go to the National Archives website for guidance on requesting personnel records for former federal civilian employees. Current federal workers can get personnel records from their human resources office.
Source: usa.gov

PeonInChief: Medicare Card Fraud

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

Medicare Supplement OR Medicare Advantage Plan, which is better?

Candid MedicareBob: I assist roughly 100 people per month with choosing which Medicare Coverage is the best for them, and 70% of the time, the choice is a Medicare Supplement Plan. This does not mean that I do not like Medicare Advantage Plans, to me it really comes down to the pricing that is available for the Medicare Supplement Plans in your area. If a Medicare Supplement Plan F, G, or Plan N is $100 or less per month, than a Medicare Supplement makes a lot of sense for most people. This being said, I do have clients that cannot afford a Medicare Supplement, this is when I assist them in choosing the right Medicare Advantage Plan for them. As I mentioned previously, both Medicare Supplement Insurance and Medicare Advantage Plans typically offer better insurance than you have had while you were working.
Source: srhealthcaredirect.com

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September 01, 2013

Medicare Hearing Aid Bill Deaf Lion

Posted by:  :  Category: Medicare

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The Congress has issued a bill that Medicare would cover the cost of hearing aids, audiologists and such. The title of the bill is Medicare Hearing Enhancement and Auditory Rehabilitation (HEAR) Act of 2009. It is a good thing because the private insurance companies tend to follow the Medicare infrastructure. If Medicare covers hearing aids, then private insurance companies will follow and start covering the hearing aids. So far, there are only 6 House representatives sponsoring this bill and the status is that it has been submitted to Committee on Finance 6 months ago. It will be a long way to get this bill go into motion.
Source: deaflion.com

Video: Does Medicare Insurance Cover Hearing Aids? : Medicare Insurance Questions

A Surprising Elder Care Management tip to Consider

I recently spoke with one of the financial advisors we list on our Support Tools page, Andy Vass, Advisor with Planning Works Chicago.  He raised a point that we tend to take for granted, and that is that Boomers have begun to retire.  Even though they are caregivers to older loved ones, they also could benefit from some tips on Medicare.  He offers the following advice to Caregivers who may be looking at their 65th birthday in the not so distant future:
Source: creativecaremanagement.com

Why Doesn’t Medicare Cover Glasses or Dental? » Toni Says

There are 2 different types of dental plans: 1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100%, basic restorative is generally covered up to 80% and major procedures at 50%. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc. 2) Discount dental plans are generally less expensive than traditional dental plans.
Source: tonisays.com

An Overview Of The Healthcare System In Australia

Medicare covers a wealth of out of hospital services, such as eye tests, various surgical and therapeutic procedures, consultation fees, tests, examinations, X-rays, dental services and a plethora of other medical services that many patients would not be able to afford otherwise. Moreover, the patient has the chance to choose the doctor that will treat him outside the hospital. Speaking of the medical fees, Medicare pays around 85% of the schedule fee for services that take place outside the hospital setting, and this is a great thing both for patients and for those who have 
Source: fin24.com

Does Medicare Cover Hearing Aids?

Medicare part B will cover the costs and related expenses associated with an artificial limb. It will also cover any of the medical treatment required, such as occupational therapy, for a patient to learn how to use this new artificial device. The insurance program also covers artificial eyes. However, Medicare does not cover eyeglasses unless part of a recovery plan for cataracts and does not cover hearing aides or devices. If you have additional coverage or use a managed care program you should consult your benefits. Many managed care programs offer services in these fields that the standard program does not cover.
Source: seniorcorps.org

Blue Medicare Regional PPO Plan

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

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September 01, 2013

Alexander, Corker Introduce Bill To Protect Tennessee Medicare Recipients Needing Medical Equipment @ CRE Interactive Public Docket on CMS Competitive Bidding Rule

Posted by:  :  Category: Medicare

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On May 21, Senators Alexander and Corker, along with Representatives Marsha Blackburn (R-Brentwood), Phil Roe (R-Johnson City), John J. Duncan, Jr. (R-Knoxville), Chuck Fleischmann (R- Ooltewah), Scott DesJarlais, (R-Jasper), Jim Cooper (D-Nashville), Diane Black (R-Gallatin), and Steve Cohen (D-Memphis) sent a letter to CMS requesting details on its policy of awarding Medicare contracts for durable medical equipment to businesses not licensed in Tennessee, a violation of the administration’s bid policy and a violation of Tennessee state law. Durable medical equipment includes products that are intended for at-home care of sick or injured individuals. The category includes wheelchairs, crutches, blood pressure monitors, and hospital beds.
Source: thecre.com

Video: Tennessee Medicare Supplement

MedicareBob’s Blog: Medicare Supplement Knox County Tennessee

Medicare Supplement Knox County Tennessee Medicare Supplement Insurance (Medigap) is for a person who would prefer to pay more money towards their monthly premium to have more coverage. A Medicare Supplement (Medigap) also provides more freedom when choosing your Doctors and hospitals. Medicare Supplement / Medigap
Source: blogspot.com

Medicare Skirting Own DME Bidding Rules in Tenn.

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

Medicare Expands Competitive Bidding Program for Durable Medical Equipment

The Competitive Bidding Program The Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the U.S. Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items.
Source: wordpress.com

All Medicare/Medicaid patients at Tennessee nursing home moving out : The Nursing Home Monitor

24-7 Press Realease reports: “We trust assisted living care facilities and nursing homes to care for our most vulnerable loved ones, those who have become unable to care for themselves. We expect that the medical professionals who run these facilities will provide the necessary support and care.” Read More…>> Unfortunately, when the facilities fail to meet their obligations, the consequences can be tragic. Moreover, it can be difficult to recognize that the facilities are not providing proper care, as elderly residents may be unable or unwilling to speak up.”
Source: nhmonitor.com

Kentucky Joins Tennessee in Doing the “Right Thing”

But here’s the rub. The lives of thousands of Elders are being impacted by the unwarranted prescription of antipsychotic drugs every day, every moment.  There are countless stories of people “coming to life” when medication use is optimized, rather than maximized.  So, we don’t have time to stay in our comfort zone any longer.  The time has come for us to take the leap and learn new ways to identify the unmet needs of individuals living with dementia.
Source: changingaging.org

The A, B, C’s, and D’s! of Medicare

Helping You Understand Your Medicare Benefits and Other Plans Many people expect to kick back and relax from budgeting during retirement years. With skyrocketing healthcare costs, it’s important that older Americans understand their Medicare benefits, the role of additional insurance, and the coordination of any other health insurance plans. Use the resources available from your doctor to understand how to take advantage of your Medicare benefits and keep your out-of-pocket expenses to a minimum. The knowledgeable team at AlphaMed is also happy to guide you in the right direction. If you have a parent that is nearing 65 years of age, make time to talk about Medicare insurance and other health concerns. It could be a life changing discussion.
Source: tnhealthandwellness.com

Retirement Session: Medicare 101

Are you planning for retirement and want to know more about Medicare? Do you think you might work past age 65 and want to know how to handle your Medicare enrollment? Perhaps you want to help your loved ones with their Medicare choices and wish you understood more? Acuna’s presentation will prepare you to make educated decisions.
Source: vanderbilt.edu

Tennessee Supplemental Insurance, Medicare Supplement Plans Tennessee

Tennessee Medicare Supplement Insurance Plans, also known as Tennessee Medigap Insurance is private health insurance that is designed to supplement Standard Medicare Insurance. The Medicare Modernization Act (MMA) encouraged the National Association of Insurance Commissioners (NAIC) to modernize the Medigap insurance marketplace. NAIC developed a revised set of Medicare Insurance Plans. These changes become effective from June 2010 and will delete some existing plans and add others.  Tennessee offers all the standardized plans and they will be the same plans offered in most other states.
Source: medigap4seniors.com

Find Pharmacist Jobs in Tennessee: Clinical Pharmacist Job job at Coventry Health Care in Southside

For detail informations about this job opportunity kindly see the descriptions. Description: GENERAL SUMMARY Performs prospective and/or retrospective drug utilization review. Coordinates the distribution of clinical drug information and educates providers a! nd staff regarding the appropriate use of pharmaceutical treatment regimens. ESSENTIAL RESPONSIBILITIES Identify opportunities within the health plans for integration of quality measures in current case management or other clinical programs.Communicate to providers and members on quality indicators for Medicare programs.Provides clinical pharmacy support to programs targeted towards the Medicare membership.Coordinates and provides drug reconciliation in Medicare members enrolled in clinical programs.Maintains communication with nurses, medical directors, and other health professionals involved in Medicare case and disease management programs.Improves quality of service to members by developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care.Collaborates with other medical personnel in developing treatment guidelines and demonstrates the ! impact of these guidelines. May participate in formulary devel! opment and management.Monitors prescribing habits of participating physicians. Makes recommendations to physicians to improve medication regimens as appropriate.Assist in development and implementation of Medicare Part D Stars Rating quality initiatives.May develop and maintain a newsletter for provider staff, promoting rational prescribing habits.Resolves pharmacy claims issues for network pharmacies not paid on-line.Performs other duties as required. Qualifications: JOB SPECIFICATIONS
Source: blogspot.com

Whistlerblowers, state Medicare fraud investigators helps Tennessee recoup big bucks for bad drug deals

Coughlan’s division was created 18 months ago and now works with TennCare, the Office of Inspector General and the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit in the TennCare provider Fraud Task Force. Together, the groups find health care fraud that rips off the taxpayer-funded TennCare program, recoups the money for the health insurance program and the rest of the funds go back to the state.
Source: medcitynews.com

Top 10 Questions to Ask Nashville Medicare Agents in Tennessee

3. What if I become ill and I’m away from my family doctor/hospital? Standard Medicare provides coverage anywhere in the United States, so you can be treated at any hospital without additional fees or penalties. Medicare Advantage and certain HMOs, however, do require for you to be treated at specific hospitals that are considered “in-network.” A Medicare agent can help you determine which plan is best for you and your lifestyle, as well as which hospitals and doctors are in the network in Nashville. 4. Which doctors and hospitals are included in my network?  Generally, residents of large cities in Tennessee like Nashville, Memphis and Knoxville will have access to a greater variety of facilities than those who live in rural areas. It is important to discuss this with your Medicare provider before you need to seek treatment, as receiving treatment at hospitals that are out of the network can be costly. 5. Do I need to buy Medicare Supplements? Medicare Supplements, also known as Medigap policies, serve a distinct purpose in healthcare, and that is to fill in the holes that may be present in standard Medicare coverage. Medigap can be very cost-effective for Nashville patients who travel away from their home doctor, as it allows them to see visit any hospital or doctor to receive care. It is also a good option for patients who require frequent check-ups and treatment for conditions like diabetes, arthritis and cancer. 6. Will my rates go up? Like anything else with a price tag, Medicare costs do increase over time. It is important to plan ahead for inevitable price increases in order to properly budget your monthly expenses. Your Medicare agent can discuss this with you and alert you to any potential premium increases. 7. Do I also need to purchase dental and vision insurance? Dental and vision care is not provided by standard Medicare. However, many Medicare Advantage programs do provide this coverage. If you require either dental or vision care, it is important to consult with your Nashville Medicare agent to find out if you should purchase separate insurance or purchase a Medicare Advantage plan that includes both. 8. Can I still get Medicare coverage if I already have health insurance? Yes. In fact, if you are eligible for Medicare you should always apply for coverage even if you already have a private health insurance plan. Medicare will often help pay for treatments that may not be entirely covered by your current health insurance plan. A Medicare agent will help you pick the right coverage that will complement your health insurance plan. 9. How much will my prescriptions cost? While Medicare Part B helps pay for a large percentage of prescription medications, there are still many drugs that are not included in its coverage policy. It is important to ask your Medicare agent or provider if the drugs you are currently taking are covered under Part B or if you will have to pay for them out of pocket.
Source: tennesseemedicareadvisors.com

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September 01, 2013

Molina Healthcare, Inc. (MOH): Molina Healthcare’s CEO Discusses Q1 2012 Results

Posted by:  :  Category: Medicare

Our comments today will contain forward-looking statements under the Safe Harbor provisions of the Private Securities litigation Reform Act, including statements regarding our Ohio contract appeal, our Texas and California operations, our expansion opportunities with regards to dual eligible integration programs and our earnings per share guidance for 2012. All of our forward-looking statements are based on our current expectations and assumptions, which are subject to numerous risk factors that could cause our actual results to differ materially. A description of such risk factors can be found in our earnings release and in our reports filed with the Securities and Exchange Commission, including our form 10-K annual report for fiscal year 2011, our form 10-Q quarterly reports and our Form 8-K current reports. These reports can be accessed under the Investor Relations tab of our company website or on the SEC’s website. All forward-looking statements made during today’s call represent our judgment as of April 30, 2012, and we disclaim any obligation to update such statements.
Source: seekingalpha.com

Video: 2009 Taste of Tuscany

Sr Medicare Account Rep occupation at Molina Healthcare in Miami

Detailed specification about this occupation opportunity kindly read the description below. Job Summary Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved mar! ket areas to achieve stated revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures. Will also be responsible for the development and management of provider, community and partnership relationships, growth campaigns and tracking. Essential Functions Knowledge/Skills/Abilities – . If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Molina Healthcare.
Source: blogspot.com

CareSource and UnitedHealth seeing early enrollment gains in Ohio Medicaid

July 1 also saw the exit of Virginia Beach, Va.-based Amerigroup Corp. and Tampa, Fla. WellCare Health Plans Inc., which together had fewer than 200,000 members. Of those who chose a new plan instead of leaving it to auto-enrollment, 80 percent picked CareSource, Morris said. It had been the second plan in regions where the ending plans operated.
Source: medbill.net

Molina Healthcare to participate in Ohio’s integrated care system for dual eligibles

Molina Healthcare (NYSE: MOH) today announced that its health plan subsidiary, Molina Healthcare of Ohio, Inc., has been chosen to participate in the Southwest (Cincinnati), West Central (Dayton), and Central (Columbus) markets under the Ohio Integrated Care Delivery System (ICDS). The Ohio ICDS is intended to improve care coordination for individuals enrolled in both Medicaid and Medicare. The selection of Molina Healthcare of Ohio was made by the Ohio Department of Jobs and Family Services (ODJFS) pursuant to the request for applications for qualified health plans to serve in the ICDS issued in April 2012. The commencement of the ICDS is subject to the readiness review of the selected health plans, and the execution of three-way provider agreements between the health plans, ODJFS, and the Centers for Medicare and Medicaid Services (CMS). Enrollment of dual eligible members in the ICDS is expected to begin on April 1, 2013.
Source: medcitynews.com

Know The Details Of Molina Medicare Advantage Plans 2012

Molina Healthcare is continuing to grow into one of the leaders in giving high quality healthcare for economically vulnerable individuals and families. Currently, Molina Healthcare sets up for the delivery of healthcare services or offers health information management alternatives for almost 4.3 million individuals and families who get their care through Medicaid, Medicare and other government funded programs in sixteen states. The Molina Medicare Advantage prescription plan is intended to assist with prescription medications. As you may know, prescription medications can be very costly out of pocket. You can pay a lot of money just to pay for monthly medications. The Molina Medicare Advantage prescription plan is made to help with that. This plan will give you a lower premium and low co-pays for prescriptions. In fact, a lot of generic prescriptions will not cost anything at all. The prescription plan is added on to other Medicare plans and it will cover the cost of prescriptions perhaps even during the Medicare donut hole.
Source: dirinsurance.com

Molina Healthcare Medicaid Plans Ranked among ''America's Best''

"Molina Healthcare is continually focused on providing access to high quality health care services for individuals and families that are among society’s most vulnerable. We are extremely proud that our plans are among America’s best, but even more importantly, we are delighted that all of our eligible plans possess NCQA’s highest accreditation of ‘Excellent’ and have earned rankings that favorably reflect the quality and value that Molina Healthcare provides to the Medicaid program and the states we serve," said J. Mario Molina, M.D., president and chief executive officer of Molina Healthcare, Inc. "I want to thank our employees and providers and congratulate our health plan leaders for their contributions toward achieving this important and valuable recognition."
Source: emaxhealth.com

Molina Healthcare brings new jobs to The Crossings in Oak Brook 

“The recent renovations and building improvements at The Crossings were key in Molina Healthcare’s decision to move here,” said Dan O’Neill, executive vice president of NAI Hiffman, who represented The Davis Companies in the transaction. “The Davis Companies’ commitment to its investment is obvious with a new HVAC system, lobby enhancements, common corridor and restroom upgrades and the addition of a 50-person conference room.”
Source: rejournals.com

FMO for Molina Medicare in FL

MedicarePlanSolutions – you are correct. Street level for FL is 450, but CMS allows reimbursement of expenses above and beyond the 450, plus overrides to managing agents for business written by their subagents. As I was saying before, if you are interested in a 473 or 493 contract level (depending on your production level and number of sub-agents), feel free to contact me at the above phone number. I also immediately vest ALL of my contracts.
Source: insurance-forums.net

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September 01, 2013

Kansas Public Radio Report on Medicare Part B DTS

Posted by:  :  Category: Medicare

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Please click on the following link to hear a report from Kansas Public Radio related to the July 1, 2013 changes in how diabetic testing strips are provided to Medicare Part B patients.  The report includes comments from Kansas Independent Pharmacy Service Corporation (KPSC) CEO, Pete Stern, expressing concern about how these changes negatively impact independent pharmacies as well as their patients.  The report also includes comments from KPSC stockholders Jeff Denton and Don Atwell of B & K Prescription Shop in Salina.
Source: kspharmserv.com

Video: Kansas Medicare Supplements

July 30, 1965: Johnson signs Medicare into law

The Medicare program, providing hospital and medical insurance for Americans age 65 or older, was signed into law as an amendment to the Social Security Act of 1935. Some 19 million people enrolled in Medicare when it went into effect in 1966. In 1972, eligibility for the program was extended to Americans under 65 with certain disabilities and people of all ages with permanent kidney disease requiring dialysis or transplant. In December 2003, President George W. Bush signed into law the Medicare Modernization Act (MMA), which added outpatient prescription drug benefits to Medicare.
Source: todayinkansas.com

Kansas Medicare Recipients To Get New Summaries

The statements will provide clearer information about the benefits residents are entitled to receive and the services that have been rendered. The statements will also provide information if a claim is denied or if one was filed for services that they didn’t receive.
Source: kake.com

Medicare Wellness Visits: They’re FREE…But What Are They?…By Lynne Kallenbach, M.D.

This is an excellent occasion to review recommended preventive testing, update your medication profile, and talk to your doctor about how to stay healthy. It also affords the chance to detect other concerns which might not otherwise be apparent and would warrant additional investigation. It can also provide a blueprint for the services and health issues that may need addressed over the next several years.
Source: kcim.com

Medicare Kansas City Health Insurance Basics

Medicare Part A is also referred as the hospital insurance and it can cover medical services such as critical care, inpatient hospital care, hospice care, home health care and short term care in skilled nursing facilities. Medicare Part A can be obtained by people who are paying Medicare taxes when they are still working. However, if an individual cannot be eligible for free benefits from Medicare Part A then he can purchase Part A coverage provided that he can meet the eligibility requirements.
Source: ehealthmo.com

Medicare Supplement Kansas City

Mutual of Omaha Effective 8/1/13, Mutual of Omaha Plan F in force Medicare supplement in Oklahoma will take a 10% rate decrease. Note: Oklahoma Mutual of Omaha Standardized plans took a rate adjustment effective 6/1/13, which included a zero percent rate adjustment for at that time Plan F.
Source: medicaresupplementkansascity.com

Licensed Medicare Appeals Nurse Consultant career at Aetna in Leawood

For complete informations about this career opportunity please read the description below. This is a telework role, but candidates must live within commuting distance of an Aetna office. All external candidates must have an active RN license in the st! ate in which they reside.POSITION SUMMARY The Medicare Clinical Appeal Team (MCAT) is part of the National Clinical Appeal Unit, and is charged with the clinical review of Aetna Medicare Advantage Plan members. MCAT nurses and pharmacists work closely with the Medicare Grievance and Appeal Unit (MGAU), providing timely clinical reviews on a diverse range of clinical topics. Each team members work is directly linked to the success of Aetna’s Medicare Star Quality Rating system. The MCAT values positive teamwork, independent thinking, problem solving skills, and drive for excellence. Responsible for the review and resolution of clinical documentation, clinical complaints and appeals of Medicare Advantage Plan members. Reviews documentation and interprets data obtained from clinical records to apply appropriate Medicare – Centers for Medicare & Medicaid Services (CMS) clinical criteria and policies in line with regulatory and accreditation requirements for member ! and provider issues. Independently coordinates the clinical re! solution with internal/external clinician support as required. Requires an RN with unrestricted active license. EDUCATION The minimum level of education required for candidates in this position is a High School diploma, G.E.D. or equivalent experience. LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN), Nursing/Licensed Practical Nurse (LPN), or Nursing/Licensed Vocational Nurse (LVN) is required.FUNCTIONAL EXPERIENCESFunctional – Nursing/Medical-Surgical Care/1-3 YearsFunctional – Nursing/Clinical Claim Review and Coding/1-3 Years Functional – Clinical/Medical/Concurrent Review/Discharge Planning/1-3 Years REQUIRED SKILLS Benefits Management/Interacting with Medical Professionals Benefits Management/Understanding Clinical Impacts Leadership/Driving a Culture of Compliance DESIRED SKILLS Leadership/Fostering a Global Perspective Service/Creating a Differentiated Service Experience Technology/Leveragin! g Technology Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position. Aetna does not permit the use of tobacco related products or drugs in the workplace. Job Function: Health Care – . If you were eligible to this career, please email us your resume, with salary requirements and a resume to Aetna.
Source: blogspot.com

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