Medicare Dental question raised again : Bite Magazine

Posted by:  :  Category: Medicare

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

Video: Does Medicare Cover Dental? What About Dental Crowns And Dentures?

Medicare – Should You Become a Provider?

Even though Medicare has traditionally not covered routine dentistry, it does cover biopsies, which a number of practices do, and it may cover procedures needed prior to jaw surgery along with a few other unique dental-related situations.  If your practice provides any of those procedures, you must be enrolled as a participating or non-participating provider for Medicare in order for your patients to receive Medicare benefits.
Source: fluenceportland.com

Mid North Coast Greens: Bring Dental Care under Medicare

The Greens have released a fully costed plan to bring dental care under Medicare. This will mean that dentists can bulk-bill dental services the same way doctors do. Read more about our plan to help people afford dental care.
Source: blogspot.com

For Example: Medicare Doesn’t Cover Dental Care

What is ironical is that yesterday while I was on hold on the telephone waiting to talk to a Medicare representative, I was informed by a recording that I am currently eligible for coverage under Medicare for cardiac screening, colon-and-rectal cancer screening, prostate cancer screening, diabetes screening, osteoporosis screening, a flu shot, and an annual examination by my primary care doctor.
Source: blogspot.com

Is dental insurance worth it?

As my heart rate starts to climb and my palms get sweaty, it can only mean one thing.  I have a dentist appointment today!  I seriously despise going to the dentist.  I can think of 100 pain inducing things I would rather do than go to the dentist.  (For example, getting punched really hard in the stomach).  It’s not the cleaning and lying with your mouth open for an hour that I dread, it is the fear of the unknown that kills me.  Will the dentist find a cavity?  Is there something wrong?  That fear causes me to lose sleep at night!
Source: medicareplansstcharles.com

Ahead Of ACA, Nearly 19 Million Young Adults Remain Uninsured.

The US News & World Report examines the impact the Affordable Care Act will have on young adults, 16 to 19 million of whom are uninsured. As Kathleen Stoll, deputy director and health policy director of Families USA explains, “Young adults are disproportionately more likely to be un- or underemployed and those that are able to find employment often earn lower wages, all of which limits their ability to access affordable job-based insurance coverage. Because young adults are over-represented among uninsured and lower-wage workers, they will benefit the most from access to financial help for coverage under the Affordable Care Act.”
Source: bluebridgebenefits.com

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

Posted by:  :  Category: Medicare

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

Video: Washington State Medicare Advantage Plans

Washington State Insurance Update: COBRA and Medicare: How to avoid a common (and costly) mistake

If you’re continuing your employer health coverage through COBRA and you become eligible for Medicare, it’s important for you to sign up for Medicare during your Medicare eligibility period. Here’s why: Health insurers generally include language in their policies that says they can refuse to pay bills if they find out that you stayed on COBRA coverage after you were eligible for Medicare. A lot of consumers get caught in this trap. Many people who are on COBRA don’t know that they should sign up for Medicare when they become eligible. Instead, they assume that COBRA will continue to pay their medical bills, so they delaying signing up for Medicare until their COBRA coverage ends. Then, months after becoming eligible for Medicare, they find out that their COBRA plan is refusing to pay for medical care that the consumer already received. They can’t backdate their Medicare enrollment, so they’re stuck with those medical bills. Yikes. Don’t get caught in this trap. If you’re on COBRA and become eligible for Medicare, sign up.
Source: blogspot.com

Obamacare deadline captivates states: Federal health insurance exchange sign up looms

Although he doesn’t know what options his family might find on the exchange, Lee plans to take a close look. He might be eligible for tax credits to knock down the out-of-pocket premium cost because his family income is lower than $94,200 — the maximum for a family of four to get a tax subsidy for buying insurance. Officials expect that Washingtonians buying insurance on the state exchange will get $520 million to $650 million in subsidies in the first two years of its operation.
Source: medcitynews.com

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

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

Breaking News: Challenge to Catholic Hospital Mergers in Washington State, Medicare Solvency and More

Kathleen is a 25 year veteran of the health care system as an independent journalist, non-proft executive and consumer advocate. She founded and managed CodeBlueNow! which successfully engaged the public on health care reform: www.codebluenow.org After a sabbatical writing her family memoirs, she returns to the health care reform debate by researching systemic failures of health care and health care reform from on independent consumer perspective.
Source: oconnorreport.com

What One Washington Could Learn From the Other About Reducing Health Care Spending

During the health care reform debate, some members of Congress, Sen. Jay Rockefeller, D-W.Va, in particular, felt something comparable to what Washington state and private insurers have put in place should be established for Medicare. They succeeded in inserting in the Affordable Care Act a provision establishing the Independent Payment Advisory Board. Ever since, other members of Congress — encouraged by the AMA and other special interests — have done their best to try to get rid of the board, which, like in Washington State, would be composed of health care professionals. Lobbyists and members of Congress would not have a seat on the board.
Source: michaelmoore.com

Medicare Insurance Plans Available Inside Of Washington State

Medicare Supplement Plan F Guide are not required but offer a particular significant blanket about financial protection. They cost a monthly premium but most find which the cost to be a little more well worth the entire protection provided. They also offer the protection many want when they go away out of their place or the culture. With a supplement you also can get care just about anyplace in the America even non emergent care. Ultimately it is a definite personal choice which can get a enhancer or not, but one most I know choose up to make in favor of the plans.
Source: salonstylesforyou.com

CMS Sequestration Guidance for State Surveyors, Medicare Part C & D Plans : Health Industry Washington Watch

CMS has issued guidance to state survey agencies explaining adjustments CMS is making to survey and certification operations to "accommodate sequestration with as little impact on the public as possible." The guidance discusses revisions in the frequency and timelines for various surveys and other survey changes in light of a 5% reduction to the FY 2013 survey and certification Medicare budget. CMS also issued a May 1, 2013 memo to Part C and D plans on sequestration, covering rules regarding reducing payments to contracted and non-contract providers, beneficiary liability under sequestration, coverage gap discount program payments, Part D risk corridor reconciliation, and Electronic Health Records (EHR) Incentive Program payments, among other topics. In a related development, President Obama has signed the sequestration order for FY 2014, as required by law, although the Obama Administration’s proposed FY 2014 budget, if adopted, would replace sequestration.
Source: healthindustrywashingtonwatch.com

Medicaid expansion will boost Washington state’s economy

But there are also important economic benefits of expanding Medicaid for both our communities and job market that Washington policymakers should be proud of. For the first several years of the expansion, the federal government will pay for 100% of the cost of the expanded Medicaid coverage (tapering and eventually holding at 90%).  This means that much-needed federal dollars will be flowing into communities across the state, bringing increased access to health care and jobs.
Source: thestand.org

IRS and Medicare to Recognize Same

“DOMA’s principal effect is to identify and make unequal a subset of state-sanctioned marriages. It contrives to deprive some couples married under the laws of their State, but not others, of both rights and responsibilities, creating two contradictory marriage regimes within the same State,” wrote Justice Anthony Kennedy. “It also forces same-sex couples to live as married for the purpose of state law but unmarried for the purpose of federal law, thus diminishing the stability and predictability of basic personal relations the State has found it proper to acknowledge and protect.”
Source: christiannews.net

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

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

Take lessons from past to guide future for Social Security and Medicare | Economic Opportunity Institute

Mark Schmitt, a senior fellow at the Roosevelt Institute, is a former editor of The American Prospect magazine and also a staff member of former U.S. Sen. Bill Bradley (D-NJ). Schmitt estimates that Social Security lifts half of all seniors out of poverty, where most of them were before it started. He says both programs have worked to transform and stabilize the lives of the elderly.
Source: eoionline.org

Understanding Medicare Premiums; Now Projected to Grow Slower

Posted by:  :  Category: Medicare

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A: Medicare premiums depend greatly on what happens to health care costs, specifically Medicare costs, in the future. No one knows for sure if the recent slowdown in Medicare costs will continue. The early indications from the Medicare Trustees
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September 02, 2013

AARP Florida Statement and Video on Medicare’s 48th Anniversary

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: Paul Ryan Speech on Medicare in Florida, on August 17 2012

Florida Blue Medicare Plans

These days, everyone is looking for a few ways to save money. With Florida Blue Medicare plans, securing a low rate is easy because they can offer discounts and reduced rates that many newer companies cannot. The reason is simple. Florida Blue has been serving the residents of Florida for generations and they’ve built a solid customer base of happy satisfied clients. As a consequence, they’re not driven by profit margins, and don’t need to be concerned with building a loyal following. Instead, they can offer deep discounts and low rates creating the most affordable Medicare plans to keep you happy.
Source: frederiksted.org

Florida Elder Law and Estate Planning: Good news, seniors: Medicare Part D costs to remain stable for 2014

If you are signing up for Medicare for the first time, you are not required to sign up for Part D. If you do not take expensive prescription medications, you may choose not to enroll. However, if you pass on Medicare D and want to sign up later, you will pay a late enrollment penalty, which increases by 1%  for each month you are not enrolled. The donut hole for prescription drugs is also shrinking. In 2013, the donut hole was the point at which you and your plan together paid $2,970 on prescriptions until you spent $4,570 out of pocket. The donut hole will shrink in 2014, when the upper end decreases to $4,550. The donut hole is expected to close entirely by 2020.
Source: blogspot.com

Shands settles whistleblower lawsuit over false Medicare and Medicaid claims

Shands officials fully cooperated with the state and federal investigation and negotiated the settlement agreement announced today to avoid long and costly litigation. While there has been no admission of liability, Shands HealthCare hospitals in Gainesville and Jacksonville will pay a total of approximately $26 million plus interest: $25.2 million to the United States under the Medicare program and $829,600 to the State of Florida under its Medicaid program.
Source: typepad.com

Florida Medicare Supplement–A Financially Sound Decision

Coinsurance –  You are responsible to pay $283 per day when you are hospitalized from the 61st day through the 90th day.  And, when you are in the hospital from the 91st day though the 150th day, you are responsible for $566 per day.  There are some lifetime reserve days with Original Medicare.  A Florida Medicare Supplement will add an additional 365 lifetime reserve days.
Source: rtcinsuranceadvisors.com

Florida Medicare Advantage Plans from Freedom Health

Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid.
Source: qooqe.com

Viewpoints: Assessing The Oregon Medicaid Experiment; Health Insurance Hysteria; In Florida, ‘Toxic Politics’ Beats Out Common Sense

The New York Times: What Health Insurance Doesn’t Do As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement. This is true. But it’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year (Ross Douthat, 5/4).
Source: kaiserhealthnews.org

An Economic and Policy Analysis of Florida Medicaid Expansion

French economist Frédéric Bastiat introduced the concept of the “fallacy of the broken window.” Economics instructors use this classic parable to explain opportunity costs and alternative uses for resources. In the parable, a shopkeeper’s son accidently breaks a shop window pane. As a result, the store owner will have to pay someone to haul the broken glass away; then order a new glass pane, hire a craftsman to install it and possibly someone else to clean up afterward. This is an example of “economic activity” created by a simple broken window. The broken window pane will create work and wages for the glassmaker, carpenter and anyone involved in the repair; but the shop owner will suffer a loss of disposable income. Moreover, society is worse off by one pane of glass that was needlessly broken. The resources employed to remove the broken glass and install a new pane could have been employed to produce something else that would please the shopkeeper more and possibly make society richer.
Source: ncpa.org

Private Health Insurers to Take Over Medicaid in Florida

“In March I joined congressional colleagues in raising concerns that the pilot program in Broward County was not sufficiently serving Medicaid patients’ best interests. I am encouraged to see that as a requirement of this expanded waiver, CMS is requiring numerous safeguards to protect Medicaid recipients across the state of Florida. It is my sincere hope that CMS will continue to take steps to ensure additional consumer protections and require oversight and monitoring of the expansion. Informing patients of their rights and benefits, pushing for increased transparency, and guaranteeing patients can continue seeing the same doctors they’ve been seeing, are vital as changes are implemented. The plans must be implemented effectively and seamlessly in order to provide Florida’s beneficiaries high quality, affordable health care.
Source: house.gov

Stories from the Field: Medicare Fraud in South Florida

The agency’s purpose is to enroll Medicare beneficiaries in their fraudulent health care program, cancelling their current Medicare plans and leaving them without the ability to receive crucial benefits. In order to carry out this scam, the agency takes advantage of the economic insecurity that many Hispanic older adults face. A recent report showed that 70.1% of Hispanic older adults live of the verge of poverty – the highest of any racial/ethnic group in the U.S. Aware of this fact, the scammers offer the beneficiaries much needed money to enroll in fraudulent health care plans. Since many live in poverty and are forced to choose between food, medication or housing, this extra money can be the difference between going to bed hungry and eating a filling dinner. In addition to this “signing bonus,” the agency attracts new clients by offering access to its beauty salon and gym.
Source: nhcoa.org

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September 02, 2013

Have you had a Medicare Supplement Rate Increase Recently?

Posted by:  :  Category: Medicare

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Sometimes people place their business with us months after we’ve talked. After speaking with agent after agent, they decide to call us back. I’ll ask them why they decided to work with us, and it’s typically the same answer: “You took the time out to make sure I understood, and you weren’t pushy.”
Source: theseniorvoice.com

Video: Reality check: Tax rates & Medicare

Increase in Medicare levy to affect other tax rates

Following the Federal Budget, the Medicare Levy Amendment (DisabilityCare Australia) Bill 2013 to increase the Medicare levy and other accompanying bills to amend other linked tax rates were introduced into the House of Representatives on May 15, 2013. The bills passed the House of Representatives and the Senate on May 15 and 16 respectively and became law on May 28, 2013 after receiving Royal Assent.
Source: com.au

Lifting the Veil on Hospital Charges

In response, hospitals were quick to point out that almost no one pays the full amount of charges on hospital bills, which represent the “asking price” for services. In general, this is true. Medicare does not pay based on hospital-specific charges or even hospital-specific costs. Medicare’s payments to hospitals are based on a formula that uses the average costs of many hospitals, and these payments are well below what hospitals typically charge. For instance, Medicare pays $14,325 for a hip replacement, not the $220,881 charged by the highest-priced Los Angeles hospital. Most private insurers pay some variation of Medicare rates or negotiated rates that are deeply discounted and bear little resemblance to hospital charges. These rates, however, are not readily available.
Source: aarp.org

More Good News on Health Care: Medicare Costs Are Down, Down, Down

The financial crisis and economic downturn […] do not appear to explain much of the slowdown. First…from 2000 to 2005, the growth in the average payment rate programwide was similar to growth in the CPI-U. Second, we did not find evidence to suggest that beneficiaries’ considerable loss of wealth and reduced income growth significantly affected their collective demand for care. Third, it is not clear whether the recession played a role in reducing the rate at which providers purchased new, cost-increasing technologies. Finally, and in contrast, some evidence suggests that high unemployment during the recession boosted providers’ incentives to deliver services to Medicare beneficiaries by reducing the demand for care in the private sector, though we could not empirically confirm the mechanisms by which unemployment might have had such an effect.
Source: motherjones.com

Hospitals Penalized for High Readmission Rates

The Centers for Medicare and Medicaid Services has opposed adjusting for such socio-economic factors as race and income, arguing that that would be an acceptance of poorer performance by hospitals that serve poorer patients, according to MedPAC. In a June report to Congress, the advisory committee suggested ways the program could be adjusted, such as comparing readmission rates for hospitals with a high percentage of low-income patients against similar hospitals, instead of comparing them to the national average. Making that change would require intervention by Congress.
Source: asq.org

Medicare, Medicaid cost Connecticut towns money for ambulance calls

“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

Surviving at Medicare Rates: An Exercise for Physicians to Consider

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

Moody’s: Low Medicare Rate Increase Bad News for Nonprofit Hospitals

The rule also takes into account several reductions required by law, including a 0.3 percentage point cut under the Patient Protection and Affordable Care Act and a productivity cut of 0.5 percentage points. CMS will also reduce pay rates by 0.8 percentage points under the American Taxpayer Relief Act and 0.2 percentage points to offset the effect of the agency’s inpatient admission and medical review criteria.
Source: beckershospitalreview.com

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September 02, 2013

CHICAGO: Accountable care groups serving Medicare patients

Posted by:  :  Category: Medicare

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— More than 200,000 Illinois Medicare patients will have their health care needs coordinated by federally designated accountable care organizations. Below is a list of the seven ACOs based in Illinois and another six based in other states but serving some Illinois patients:
Source: theolympian.com

Video: Attention Residents on Medicare in Illinois: information on Medicare Supplements

Activists Want An Immediate End To Illinois' Medicaid Privatization Contract

The approximately 20 activists at today’s protest say the Maximus contract causes unjust Medicaid disqualifications, violates workers’ rights and costs the state more than if the job were done in-house. They called on Gov. Pat Quinn and HFS Director Julie Hamos to end the contract now, asking that the officials not wait until December 31 to fire Maximus. Quinn’s administration has not yet said if it would appeal the arbitrator’s ruling in court, or bring on the 100 extra state workers needed to cover the job Maximus is doing. According to AFSCME, the state would save $18 million a year by having public employees do the work instead of shelling out $76 million for a two-year contract with Maximus.
Source: progressillinois.com

Illinois Health Care Reform Enrollment Toolkit! : HIV Health Reform

ADAP advocacy Bridge to 2014 California Healthcare Reform Case Stories comments to HHS Congress Deficit Reduction Election 2012 enrollment essential health benefits fact sheet federal budget federal implementation health care reform & prevention Health Care Reform and YOU health home health reform & HIV 101 HHCAWG HIVMA HLS/TAEP HRSA Illinois Marketplace & Exchange Medi-Cal Questions Medicaid Medicaid Expansion Medicare NASTAD National HIV/AIDS Strategy Navigators private insurance providers public input regulations Ryan White CARE Act Sebelius Spanish Speaking Resources state & local implementation state advocates Supreme Court toolkits Unwrapping ObamaCare webinar women
Source: hivhealthreform.org

Will County Illinois Medicare Supplement Quotes

Tagged With: Aflac Medicare, Bache, Cigna Medicare, Illiinois Medicare, Medicare, Medicare Quotes, MedicareBob, Medigap, Robert Bache, Senior Healthcare Direct, Will County Medicare Supplement Insurance, www.SrHealthcareDirect.com
Source: srhealthcaredirect.com

MedicareBob’s Blog: Cook County Illinois Medicare Supplement Quotes June 2013

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

Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments'; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.   “In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”   “On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”
Source: wordpress.com

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September 02, 2013

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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

Video: Medicare Part D – 5 Things To Know Before You Enroll in a Part D Plan

The Generation Above Me: Part D Open Enrollment

Fall is just around the corner. That means that it’s almost time for the annual open enrollment period for Medicare Part D, Prescription Plans.  Between October 15th and December 7th of each year, Medicare beneficiaries can compare plans. As a result, they can switch or continue with their current plan. For more information on Open Enrollment dates and other the important events between September and January regarding Part D, see this brochure created by CMS (Centers for Medicare and Medicaid Services).
Source: blogspot.com

Does the “IRMAA” Income Rule to Medicare Part D Affect You??? » Toni Says

If your income is above a certain limit, then you will have to pay more.  Since your additional amount is $29.90, it tells me that your modified adjusted gross income as reported on your IRS tax return from 2 years ago was $107,001-$160,000.  The bottom line is if your income is over $85,000 as an individual or $170,000 for a couple, and you have your Medicare prescription drug plan from a Medicare Advantage (Part C) or Stand alone Medicare Prescription Drug plan (Part D), you will have more premiums deducted from your Social Security check.
Source: tonisays.com

Florida Elder Law and Estate Planning: Good news, seniors: Medicare Part D costs to remain stable for 2014

If you are signing up for Medicare for the first time, you are not required to sign up for Part D. If you do not take expensive prescription medications, you may choose not to enroll. However, if you pass on Medicare D and want to sign up later, you will pay a late enrollment penalty, which increases by 1%  for each month you are not enrolled. The donut hole for prescription drugs is also shrinking. In 2013, the donut hole was the point at which you and your plan together paid $2,970 on prescriptions until you spent $4,570 out of pocket. The donut hole will shrink in 2014, when the upper end decreases to $4,550. The donut hole is expected to close entirely by 2020.
Source: blogspot.com

Medicare Part D: A First Look at Part D Plan Offerings in 2013

The analysis is the first in a series of planned reports examining the private plan choices available to Medicare beneficiaries for 2013. It is authored by researchers at Georgetown University, the Kaiser Family Foundation and NORC at the University of Chicago.
Source: kff.org

Humana Walmart Prescription Rx Plan

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
Source: qooqe.com

Individual Health Insurance Market under ACA: Lessons from Medicare Part D

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

2014 Medicare Part D Costs to Remain Stable

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

Rollout Resembles Some Of The Problems Of Medicare Part D

NPR: Messy Rollout Of Health Law Echoes Medicare Drug Expansion It hasn’t been a good week for the Affordable Care Act. After announcements by the administration of several delays of key portions of the law, Republicans returned to Capitol Hill and began piling on. “This law is literally just unraveling before our eyes,” said Rep. Paul Ryan, R-Wis., at a hearing of the House Ways and Means Committee. … [But] “About this time in 2005, the percentage of people who had an unfavorable opinion of the law was actually higher than those who had a favorable opinion,” says Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute (Rovner, 7/12).
Source: kaiserhealthnews.org

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September 02, 2013

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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

Video: Medicare Supplement plan F High Deductible Explanation

Medicare Announces 2011 Deductible and Coinsurance Rates

Last week, Medicare announced on CMS.gov in a fact sheet titled “Medicare Premiums, Deductibles for 2011″. This fact sheet gives detailed information on the increases to the yearly premium and deductible Medicare patients will have to face in the coming year.
Source: about.com

Physicians Advantage Services, Inc

Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. By law, the standard premium is set to cover one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over, plus a contingency margin. The contingency margin is an amount to ensure that Part B has sufficient assets and income to (i) cover Part B expenditures during the year, (ii) cover incurred-but-unpaid claims costs at the end of the year, (iii) provide for possible variation between actual and projected costs, and (iv) amortize any surplus assets.  Most of the remaining Part B costs are financed by Federal general revenues.  (In 2012, about $2.9 billion in Part B expenditures will be financed by the fees on manufacturers and importers of brand-name prescription drugs under the Affordable Care Act.)
Source: physiciansadvantage.net

Marshall Elder and Estate Planning Blog: Medicare Premiums for 2011 announced

For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium.  The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month.  For additional details, see our FAQ titled: “2011 Part B Premium Amounts for Persons with Higher Income Levels”.
Source: blogspot.com

A Primer on Medicare Financing

It also describes the expected effects of provisions in the 2010 health reform law on future Medicare spending. The primer reviews the financial obligations and out-of-pocket spending for people covered by Medicare, outlines several ways to assess Medicare’s long-term fiscal outlook, and discusses future financing challenges facing the program.
Source: kff.org

Jim Thomason’s “The Business of People”: High Deductible Plans and Medicare Part B Don’t Go Together

Now before your eyes gloss over, let’s walk through it. Medicare pays 80% (you pay 20%) after a $162 deductible. Medicare is always the payer of last resort, but it will pay its portion between the $162 Medicare deductible and the $1,200 Blue Cross deductible. That totals $830 in benefits ($1,200 – $162 deductible = $1,038 x 80%). After you’ve reached $1,200 in medical bills your Blue Cross insurance kicks in at 80%, making Medicare secondary. In the coordination of coverage rules for Medicare, it will pay whatever Blue Cross does up to the limits of Medicare’s coverage. Because Blue Cross pays 80%, and Medicare pays 80%, Medicare will pay nothing else. You pay 20% until your total out of pocket reaches $8,800 (a rarity)and then Blue Cross pays 100%. The coordination of these two coverages means that you’ll pay $567 more in Part B premium that you’ll ever receive in benefits. Bottom line: if you have Parts A and B you don’t need to elect our coverage. If you have Part A and want a Blue Cross High Deductible Plan you should not elect Medicare Part B.
Source: blogspot.com

Refund of Social Security and Medicare Taxes for Nonresident Aliens

“I was wondering if you would be able to help me find the answer to my question. I did my undergrad here in the US and am a current student in a Masters program also in the US as an international student. I was on my OPT (optional practical training) from August 2004 to August 2005. Now, I have researched quite a bit and also called the tax refund number listed on the IRS website to confirm if I am eligible for a refund of my Social Security and Medicare taxes and so far, all my research points to a yes. Since I am on an F-1 visa and have never worked without INS authorization under a student visa, all the articles I have read state that I am allowed to file for a social security/medicare tax refund. Now I did not know this while I was on my OPT. But since my OPT ended August 2005, do you think I can still file for my refund for Social Security and Medicare taxes?”
Source: about.com

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September 02, 2013

Medicare Blue Button Makes Health Records Accessible

Posted by:  :  Category: Medicare

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But the body of information doesn’t end there. With the advent of Medicare Blue Button—a program that lets people download personal health records to a file—patients can also come to appointments with their medical history in tow. Until recently, retrieving medical records was the duty of a physician’s administrators or a third-party record retrieval firm, but now Medicare patients can use Blue Button to avoid waiting for their information to arrive at the doctor’s office.
Source: altmannporter.com

Video: Blue Cross Medicare Advantage – Popular Plan Options

Florida Blue Medicare Plans

Most people realize that while the coverage is similar, all Medicare plans are not priced the same. The truth is, there are significant differences between companies in out-of-pocket expenses as well as premiums and different providers charge different rates. Florida Blue Medicare plans have the advantage of being well known and reputable, making it possible for them to offer the most competitive prices without worrying about profits. As an established company, Florida Blue can offer deep discounts and provide the same quality coverage at lower rates on account of customer loyalty and the fact that they already have a large base of happy and satisfied customers.
Source: davebroggi.com

Florida Blue Medicare Plans

One of the benefits of choosing Florida Blue Medicare plans is access to value added services that help you stay healthy and informed. With a variety of online tools and resources, it’s possible to do everything from check availability for a new doctor and estimate costs before going to an appointment to getting expert advice on important health care decisions. These services and more are provided free of charge by Florida Blue and are available to each and every Medicare member, making it even easier to make important health care related decisions.
Source: diannebos.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

Sr Contract Monitoring Analyst

Five to seven years experience in quantitative business analyses and statistical modeling (preferably healthcare related).Proven analytical experience using Enterprise Guide SAS, database query capabilities and ability to evaluate data at various levels of detail (preferably Enterprise Guide SAS) *Subject Matter Expert on Medicare Part D and CMS requirements and Pharmacy Benefit Manager (PBM) technical and operational experience is preferred
Source: kdnuggets.com

Blue Shield of California: Medicare Systems Strategy

Medicare Systems Strategy was another major project for which I was primarily responsible. The challenge here was to allow users to update their profiles in a more clear and easy manner. I revised the information architecture to group similar items and designed an accordion based solution to minimize the number of simultaneous choices. Overall, quite an improvement!
Source: peterspannagle.com

Blue Shield of California Scales Back Coverage for Proton Beam Therapy

Blue Shield of California is the latest of a flurry of insurers to step back from proton beams. Aetna stopped covering proton beam therapy for prostate cancer Aug. 1. Cigna is planning to review its policy for proton beam coverage later this year. Regence — a Blue Cross Blue Shield plan in Oregon, Washington, Utah and Idaho — stopped covering the therapy three years ago. Pittsburgh-based Highmark and BCBS of Kansas City also have “long-standing positions against it,” according to the report.
Source: beckershospitalreview.com

Medicare FAQ: What is Original Medicare, Part A and Part B?

These individuals will want to enroll during their seven month Initial Enrollment Period (IEP), which starts three months before they become Medicare eligible and lasts for three months afterwards. If they do not sign up during their IEP, they can sign up during the General Enrollment Period. This enrollment period lasts from January 1 and March 31 of each year with coverage starting on July 1. However, this means that you will have to pay a higher monthly premium for late enrollment. The length of these late enrollment penalties will depend on how long you could have enrolled in Part A and/or Part B coverage and did not.
Source: planprescriber.com

New Models For Care Coordination And Accountability Cut Costs, Study Finds

The New York Times: Lessons in Maryland for Costs at Hospitals Yet Western Maryland Health Systems, the major hospital serving this poor and isolated region, is carrying out an experiment that could leave a more profound imprint on the delivery of health care than President Obama’s reforms. Over the last three years, the hospital has taken its services outside its walls. It has opened a diabetes clinic, a wound center and a behavioral health clinic. It has hired people to follow up with older, sicker patients once they are discharged. It has added primary care practices in some neighborhoods. The goal, seemingly so simple, has so far proved elusive elsewhere: as much as possible, keep people out of hospitals, where the cost of health care is highest. Here, the experiment seems to be working (Porter, 8/27).
Source: kaiserhealthnews.org

Everything Elder Law: Medicare Blue Button Information Can be Accessed Using a Smartphone App

What happens when your dad who lives 1,000 miles away comes for a visit, gets sick, and needs medical care? How can local doctors access his medical information? MyMedicare.gov’s Medicare Blue Button is a computer program that allows patients on Medicare to download their medical history into a simple text file on their personal computers. Now, seniors can get the same Medicare data on their smartphones. Blue Button downloads three years of medical history and the Humetrix iBlueButton, a smartphone app, translates and displays the information in a simple-to-understand way on your mobile device. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications. The Blue Button service is available from the federal government for veterans as well as Medicare beneficiaries. More similar apps are in the development phases and will become available within the next twelve months. So, now when you take your dad who is visiting in for medical care, he can hand over his smartphone and provide his medical history to the doctor. There are privacy concerns, however, about electronic health records and this type of information being shared on smartphones. Federal Trade Commission rules don’t extend to medical information on a smartphone. Medical information on a smartphone app is not going to be protected beyond what’s in the privacy policy for the app or what’s the privacy policy for the social networking site. So be aware before you share! Did you know that, like medical records, your Advance Medical Directives can be stored electronically and available when they are needed most (on computers, but not via smartphone apps, yet)? These documents include your Living Will, Health Care Power of Attorney, HIPAA Release, Organ Donor Form, Funeral Arrangements, and all other Advance Directives. At The Fairfax Elder Law Firm of Evan H. Farr, P.C., we offer a service called
Source: blogspot.com

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September 02, 2013

HHS pushes back deadline for signing final healthcare plans

Posted by:  :  Category: Medicare

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The Department of Health and Human Services notified insurance companies on Tuesday that the agency would not be signing final agreements with insurance plans to be sold on the federal health insurance exchanges until mid-September, later than the original Sept. 5-9 timeframe, Reuters reports.
Source: dailycaller.com

Video: Politics Breaking News: Feds Step Up Medicare Anti-Fraud Efforts

7 Notable Developments in Hospital Fraud & Abuse Enforcement

U.S. District Judge Terrence Boyle voiced frustration about the lack of criminal charge against WakeMed. He initially rejected WakeMed’s proposed deal for deferred prosecution in January, reportedly shredding the 116-page proposal in less than half an hour and calling it “a slap on the hand.” Judge Boyle finally approved a deal in February, in which federal prosecutors will provide the court with all reports tracking WakeMed’s compliance with an $8 million settlement. Prosecutors also agreed to defer prosecution against WakeMed for two years. 

Judge Boyle based his approval on the reasoning that a conviction could harm patients. If the hospital were convicted of a felony, it would become ineligible for Medicare and Medicaid and would likely shut down.
Source: beckershospitalreview.com

Healthcare Fraud Shield’s Latest Article: Fraud Schemes that Hit Home!

Unfortunately, identifying and proving HHC fraud is not an easy task.  Providers and agencies often doctor and forge medical records, making medical record reviews unreliable.  Additionally, home health records are often voluminous and can prove to be a large review if many patients are involved.  When medical records are reviewed, investigators should look out for cloned records, pay attention to the credentials of the providers signing the daily treatment sheets, and ensure the dates of service billed on a claim match what is in the record, among other things.
Source: wordpress.com

High infection rates fuel federal probe of hospital chain

At Prime Healthcare Services, the chain under investigation, rates for the blood infection septicemia stood at 16 percent–triple the national average–in 2008. At the same time, death rates across the 13 Prime hospitals from the infection reportedly were 38 percent below the national average, triggering accusations of inflated statistics for profit. The Times notes that Medicare gives more in reimbursement dollars to hospitals to treat septicemia than other hospital-acquired infections. 
Source: fiercehealthcare.com

High Cost of Medicare Fraud

While new age technology can identify patterns there by eliminating some fraud, common sense, physical investigation and old fashion leg work has its advantages too. In one case a hidden camera recorded a very active and healthy 82 year old grandmother telling her doctor she was in good health, yet official documentation indicated she was homebound, needed assistance in all activities and was unable to safely leave home. Recently in 2011, a 9 state raid involving health care facilities arrested more than 100 doctors, nurses, therapists and healthcare executives for racking up more than $200 million in fraudulent services and medicines never received. In Houston a nurse was sentenced to 8 years in prison after she was convicted for her participation in a fraud scheme that netted over $5 million.
Source: mkcmedicalmanagement.com

Whistleblower Support Fund

That’s the clear and thoroughly disturbing conclusion to be found in a revealing TAF study of the “Top 20” fraud lawsuits (ranked by dollar amounts) to have been decided by court judgments or agreed-upon settlements in recent years.  Amazingly, the list of penalty awards – as adjudicated under legal procedures mandated by the U.S. False Claims Act – contains no fewer than 19 healthcare or health insurance entities . . . and only a single financial entity who isn’t engaged in the business of health insurance or medical care.
Source: whistleblowing.us

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