Medicare Supplement OR Medicare Advantage Plan, which is better?

Posted by:  :  Category: Medicare

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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

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

I Am on a Medicare Advantage Plan But Am Unable to Access The Providers I Want.

Because Medicare pays the Medicare Advantage plans to take care of you, and the Plans pay the medical groups, with most medical groups you need to notify your Plan by the 15th of a month what medical group/primary care physician you want to switch to as of the 1st of the following month.  You will need to confirm that you Plan you are selecting is contracted with that medical group and that your new primary care physician accepts that Plan and is accepting new patients.
Source: personalmedicareadvisor.com

MedicareBob’s Blog: HMO Medicare Advantage Plans

What is a Medicare Advantage (Medicare Part C) HMO Plan? HMO (or health maintenance organization) health insurance plans provide insurance if you receive services from an in-network provider. The only out-of-network services available are those on an emergency basis. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary for high-cost services like MRIs or surgeries. HMOs typically provide richer coverage than a PPO health insurance plan. However, they often cost more due to the better benefits. HMO plans often do not include deductibles, but copays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member Because an HMO plan will not pay for you to see an out-of-network provider except in an emergency, it is very important to ensure that your existing doctors and a high quality hospital in your area are in your network. This ensures that in both routine and unforeseen circumstance you have access to high quality health care providers in your area. HMOs were introduced in 1974 by enabling federal legislation that ultimately spurred the creation and growth of many large HMOs across the country. HMOs came under heavy criticism because of their tight cost controls, referrals, second opinions, pre-certifications, and other stringent cost controls. Many of those cost controls have been replaced with higher cost-sharing. For instance, for many HMOs a specialist referral has been replaced with a split copay for physician visits. Copays that might have been $20 to see a physician with a specialist referral have largely been replaced with a $20 copay for physician, $40 copay for specialist setup. But the HMOs still retain their rich preventive and other benefits provided you stay in network. CLICK HERE TO VIEW THE MEDICARE HMO PLANS IN YOUR COUNTY. CLICK HERE TO WATCH A 2 MINUTE VIDEO ABOUT MEDICARE HMO PLANS.
Source: blogspot.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

Is a Medicare Advantage Plan Right for Me?

Standard Medicare insurance typically pays for all necessary medical expenses for individuals who are old enough to receive Medicare or for those who have a disability. However, this sometimes forces patients to find a new physician that will accept Medicare. Medicare Advantage eliminates many of these hurdles because the benefits are paid directly to the private insurance company as part of the monthly premium. This eliminates the problem of having to find a medical facility that accepts Medicare. However, it also means that the patient may have to pay additional premiums and co-pays. They are responsible for co-pays just as they would be if they did not have Medicare insurance at all. Moreover, they are also responsible for any additional monthly premiums that is beyond the amount which is covered by Medicare.
Source: askamydaily.com

Medicare Advantage gains popularity

Enrollment in Medicare Advantage, the private insurance segment of the popular U.S. healthcare program for the elderly, is expected to grow 11 percent next year while premiums remain steady, government health officials said on Wednesday. Growth in Arizona is predicted to be even higher. The U.S. Centers for Medicare and Medicaid Services estimated that 14.5 million people will enroll in Medicare Advantage plans in 2013, based on insurance industry expectations. That is up from 13.1 million this year.
Source: arizonamedicareadvisors.com

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

What is the difference between Medigap and Medicare Advantage?

Medicare Advantage Plans work differently than Medigap Plans, they are not supplements and they do not supplement Medicare. Medicare Advantage Plans take the place of Medicare as far as paying for medical services. If you have a Medicare Advantage Plan, Medicare will not pay your medical bill, the Medicare Advantage Plan will. Medicare Advantage Plans are administered by private company’s that are contracted with Medicare. You must have both Parts A & B of Medicare and continue to pay your Part B premium. Medicare Advantage Plans are also referred to as Medicare Part C.
Source: reed-insurance.net

What is a Medicare Advantage Plan?

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

Not Happy with Your Medicare Advantage Plan? Change it!

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Medicare Health Professional News

Posted by:  :  Category: Medicare

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Using the Healthcare Identifiers (HI) Service, update personal or organisation information, manage links with other service providers, search for Healthcare Provider Identifier—Individual (HPI–I) numbers and Healthcare Provider Identifier—Organisation (HPI–O) numbers, and check provider status.
Source: gov.au

Video: Medicare Basics

Survey: Physicians Mixed on Medicare Payment Data Transparency

The survey was spurred by the recent movements in healthcare data transparency along with an overturned ruling that prevented the Centers for Medicare and Medicaid Services (CMS) from releasing information about payments to individual physicians, ACPE says. In May and June, the CMS released data on hospital outpatient charges for hospitals nationwide. Local governments, like in North Carolina, have gotten in on the act, requiring hospitals to provide public pricing information on medical procedures and services.
Source: healthcare-informatics.com

CMS 1500 Medicare Claim Form Gets ICD

CMS also released a tentative outline for phasing in the new documentation. The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted. NUCC notes that the timeline may change, and urges providers to check with their payers and clearinghouses to determine when they will begin to accept the new 1500 form. NUCC has also provided an instruction manual for using the new 02/12 form, and asks providers to keep an eye out for any CMS updates to the process.
Source: advanceweb.com

Income Thresholds For Medicare Part B And Part D Premiums

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

Medicare Expands Competitive Bidding Program for Durable Medical Equipment

You can also get the supplies from a store or pharmacy that accepts "Medicare assignment." This means that the store will accept the Medicare-approved amount as payment in full and that you cannot be charged more than a 20 percent copay (after you meet your annual deductible). A Medicare contract supplier can’t charge you more than that for the equipment or supplies included in the competitive bidding program.
Source: aarp.org

Medicare Ruling Would Hurt Alzheimer’s Patients

age population alcohol alzheimer analysis blog budget budget proposal budgets business certification debt economic disaster economic progress economic recovery economics economy econostats employment report exchange rate federal federal budget federal reserve federal spending forestry GDP government heritage foundation jobs legislatures medicare minimum monopoly new jobs Obama pension plans recession sequester shocking stats stats taxes unemployment rate unemployment rates US wage world bank
Source: econostats.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

Romney Lies About Medicare/Medicaid Change Of Address Form

There were periods during my government service when the business-does-it-this-way was fashionable.  Public private partnership (acronym PPP) became popular.  At some point what tended to happen or be realized was the understanding that the public service does not have, cannot have the same “bottom line” as a for-profit organization.  Wall Street exemplifies the outsize for-profit situation these days…I do not think most people want the government to emulate that value system when it comes to exercising government authority.  And, frankly, when you look at it, the basic myth at bottom of the business school takeaway about efficiency has a lot of flaws…not the least of which is that large, major corporations with their overpayment of failing executives and with their taking-care-of-the-top first motif are the opposite of even the the narrowest definition of “efficiency.”  
Source: talkleft.com

Comparison of Medicare Premium Support Proposals

Posted by:  :  Category: Medicare

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The brief compares the premium support provisions of these proposals, including how the level of premium support for beneficiaries would be determined; whether traditional Medicare would remain an option; what protections would be provided for low-income beneficiaries; and whether and how the proposals would cap federal spending on Medicare. These differences have important implications for Medicare beneficiaries, the federal budget, health care providers, and private health plans.
Source: kff.org

Video: Cassidy Discusses Medicare Premium Support Reform Proposal

Income Thresholds For Medicare Part B And Part D Premiums

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

Families USA Executive Director Explains How To Understand Medicare Premiums

Part D premiums are similarly tied to the costs of prescription drugs. Medicare Advantage premiums are determined by a more complicated process, but they also reflect trends in costs. Because Part D and Medicare Advantage plans are run by private companies, premiums can vary a lot.
Source: smmirror.com

Medicare Open Enrollment Period Begins Oct. 15, 2013

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: disabled-world.com

Medicare Increase $1 In Price From The Past Three Years

USA Today: Medicare Premiums To Remain Stable In 2014 Medicare Part D premiums will average about $31 in 2014 — up from $30 for the past three years. The Part D deductible will fall from $325 to $310 in 2014. “There is continued very strong competition within the Part D plan,” said Jonathan Blum, deputy administrator and director for the Center of Medicare. When the coverage gap program began, “there was lots of concern that filling in the doughnut hole would cause Part D costs to go up” (Kennedy, 7/30).
Source: kaiserhealthnews.org

Medicare Insurance Provider San Diego Talks Part D

SBHIS.net can help you enroll in the Part D prescription drug plan.  The Medicare Prescription Drug Plan adds drug coverage to your existing Medicare coverage. It can help you save thousands. According to the latest reports, individuals saved $1,061 per year on average. That’s a significant figure for most seniors on a tight budget.
Source: pomeradonews.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

ibm medicare options: IBM Medicare Extend Health Transition Questions, Questions, Questions

I just created a list of questions for Extend Health and thought I would post them up as they might help you think about what you want to ask them as you begin to understand this change.  Also, I don’t understand the HRA subsidy so ignore what I said in my last post.  I believe I am wrong about the premium subsidy going into the HRA because on page 9 of their brochure they imply that the SHAP process stays the same.  My questions so far are: 
Source: blogspot.com

CMS Projects $31 Monthly Premium for Medicare Part D in 2014

The deductible for Part D will be reduced from $325 in 2013 to $310 in 2014 as provided in the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). In addition, the coverage gap, referred to as the “donut hole,” will be reduced further, as it will each year until it closes in 2020, while the discounts available during the gap period will continue. About 6.6 million Medicare beneficiaries who reached the initial coverage limit have saved about $7 billion in drug costs as a result of PPACA, averaging $1,061 per beneficiary, according to the agency’s calculations.
Source: wolterskluwerlb.com

Premium support could inject competitition into Medicare

At its core, the premium support model would have private plans competing with Medicare fee-for-service (FFS) on a cost basis. Benefits would be pre-defined by law, and the Medicare program would provide vouchers (pegged to the second-cheapest plan in their region) that would be used to purchase Medicare-equivalent coverage. Any cost above the voucher would be borne by the beneficiary. In the end, whichever program could pay for the same benefits at lower costs would come out on top.
Source: washingtonexaminer.com

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September 06, 2013

REVISING SPECIALTY TIERS: PROTECTING MEDICARE PART D BENEFICIARIES FROM BURDENSOME COST SHIFTING

Posted by:  :  Category: Medicare

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“The National Psoriasis Foundation supports the introduction of this legislation, which will provide an additional level of protection for Medicare beneficiaries with chronic conditions, like psoriasis and psoriatic arthritis,” said Leah Howard, director of government relations and advocacy at the National Psoriasis Foundation and MAPRx Coalition member. “Specialty tiers for expensive medications, such as biologic drugs used to treat psoriasis and psoriatic arthritis, require individuals to pay high copayments and can restrict access to needed medications. Without access to prescribed medications, these patients risk health complications and, sometimes, even permanent disability.”
Source: maprx.info

Video: Medicare card scam targets bank info

Senator Asks States If They Alert Medicare to Problem Physicians

Chicago psychiatrist Michael Reinstein wrote an average of 20,000 prescriptions for the antipsychotic clozapine in Part D each year between 2007 and 2009, and another 14,000 in 2010. Last year, he was suspended from Illinois Medicaid, and the Department of Justice has sued him for fraud. But he remains able to provide services under Medicare. Reinstein has treated patients at more than 30 Chicago-area nursing homes and long-term care facilities. He has defended his prescribing in media interviews.
Source: propublica.org

Medicare Benefits and Cost

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

Georgia offering Medicare info

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

Question about Medicare as primary & coverage of meds

Hi Allisa! I *think* I can shed a little light on this issue for you as I went through the exact same thing a couple years ago! I was scared to death just as you are! Maybe even more so because I was pregnant and had a baby while Medicare was my primary! So, I’ll start by saying everything turned out FINE! I had to go on COBRA while my husband was between jobs a couple years ago, and with COBRA, Medicare becomes primary. I only had Medicare as primary for a few months until my husband started a new job and I got on his employers group plan and that became primary. But I think I can still help you out! Nothing much changed in terms of prescription coverage. I continued to fill my prescriptions under Blue Cross/Blue Shield since I didn’t have a Part D plan. The only prescription that did change was Pulmozyme, because Medicare part B covers Pulmozyme. In that case, your secondary plan should pick up whatever medicare doesn’t cover, just leaving you with your regular copay. So in order for this not to become confusing, what I did was fill all my regular prescriptions at Walgreens through my secondary and gave them no Medicare info (since it didn’t apply to prescriptions) and then filled my Pulmozyme through CF Services, where they billed Medicare as primary and then my secondary. It worked pretty darn smooth. So to answer your question, YES, your secondary would cover your prescriptions since you do not have a Part D plan. As far as your secondary picking up what Medicare doesn’t pay….. Yes, sometimes it will. If it is something that is a COVERED service under the terms of your secondary insurance, and it is NOT a covered service by Medicare, your secondary has to pay if Medicare denies it. Or, if Medicare pays less than what your secondary would have paid if they were your primary, then they will pick up the difference. Basically the secondary looks at the claim and figures out what they would have paid on the claim if they were your primary, then they will pay up to that amount if a balance remains after Medicare pays. Also, Medicare is cut throat when it comes to negotiating rates with hospitals. So usually for me, by the time the hospital gave me the Medicare rate, and Medicare paid whatever it paid, it was less than what my secondary would have paid. So my secondary ended up not having to pay much if anything. For me, for the most part having Medicare as primary worked out pretty well. I didn’t pay much out of pocket at all. I really think you’d be fine with it as your primary, as long as your husband’s potential employer has a decent prescription plan. I realize that a lot of what I wrote may be hard to understand as I had a hard time trying to explain it! Please let me know if you need clarification or have more questions! Take Care, Autumn 32 w/CF
Source: cysticfibrosis.com

General Dynamics to Help CMS Run Medicare Info Systems; Marcus Collier Comments

Air Force Army ba BAE BAE Systems Boeing Booz Allen Hamilton business news CACI Contract Awards CSC Defense Contracting Defense Department Defense news Department of Defense Executive moves featured Financial News General Dynamics government contracting government contracting News Harris L-3 lmt Lockheed Martin ManTech market news Navy News noc Northrop Grumman NYSE: NOC nyse: sai nyse ba nyse gd nyse lmt nyse news nyse rtn Raytheon rtn SAIC Technology News U.S. Air Force u.s.army u.s navy Contract Awards (4479) Executive Moves (1395) Financial Report (982) M&A Activity (657) News (7282)
Source: govconwire.com

Information for PWD's on Medicare

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

Social Security and Medicare Should Not Be Used to Reduce Deficit

Crack down on waste and inefficiency: The U.S. health care system wastes as much as one-third of all spending because of inefficient payment systems, uncoordinated care, mistakes, duplication and unnecessary paperwork. We must step up efforts to detect fraud and crack down on criminals who file false Medicare claims. We need to focus on improving care and cutting unnecessary tests and procedures, which are often the result of payment incentives and fear of litigation.
Source: aarp.org

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September 06, 2013

Do I need a Medicare Supplement?

Posted by:  :  Category: Medicare

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

Video: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

Utah Medicare Supplements

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Compare Medicare Supplement Plans Online

One final thing to think about when looking at Medigap coverage is your out-of-pocket limit. This is also something that is going to differ from one policy to another. In most cases, the Medigap policy is going to cover 100% of the services that are necessary once you have reached your annual out-of-pocket limits. This is something that should be considered carefully, especially if the time comes when you need regular care.
Source: thinkitout.net

What Medicare plan & supplemental protects best for fewest out

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

Medicare Supplement Plans & Benefits

Plans with the same letter offer the same benefits. To clarify, the benefits for a Medicare Supplement Plan A in Los Angeles California is the same as Miami Florida. However, prices may vary due to other factors, and it is always advisable to shop around before enrolling. If you are confused and need answers now, take advantage of our FREE Consultation to answer your questions. When you call Mature Health Center at 866-800-5566, a professional will help you avoid the mistakes that most people make, and remove the confusion associated with each plan. The deadlines for Medicare Supplement have been moved up, so please be aware of this. Call Us today, and all of your questions will be answered, so you can sign up for a plan that is exactly what you expected with NO Surprises.
Source: paleonista.com

An Explanation Of Medicare supplement plan F

Medicare supplement plan F is the most sought after Medicare supplement plan because it provides the most coverage. It is also the most expensive of the plans. Medicare supplement plans cover the deductibles in part A, which is the hospital portion of Medicare, and the 20% that Medicare does not cover, which is the doctor’s portion of the plan. The plans are labeled plans A, B, C, D, F, G, K, L, M, and N.
Source: willkapampa.org

Why are Seniors are Paying too Much for their Medicare Supplement Plan?

The best way to predict the future is to create it. Let’s do it together with Empower Network. If an opinionated,nosey,noisy big mouthed sarcastic Latina like me can do it. If a formerly homeless hippie beach bum can do it. You can do it. It’s not that hard but there are some tricks and techniques you need to learn. Come on. Take a chance. It’s only $25 bucks a month. Click here to learn more and possibly change your life! .
Source: empowernetwork.com

Seniors See Value in Medicare Supplement Plan G

Why would an insurance company charge a consumer $500 to cover a $147 expense? The better question might be; why would anyone pay it? The answer to the first question is two-fold, first of all, because they can and secondly, because of Federal laws which require Medicare supplement companies to accept without underwriting individuals losing group insurance and/or leaving a Medicare Advantage plan, companies incur greater claims losses since they can’t weed out the sick individuals. This law does not apply to Medicare Supplement Plan G. Now to answer the question, why would anyone pay so much to cover such a little difference? The answer is simply because they don’t know any better. Whose fault is it that they don’t know any better? That blames rests on the consumer themselves for not doing adequate research, the insurance agent who is not knowledgeable or unscrupulous, the insurance company which is profit driven and the Medicare system for not providing proper education.
Source: askmedicareblog.com

The Cost of Minnesota’s Average Medigap Plan

While most of America (47 states) must consign to the National Association of Insurance Commissioners (NAIC) standardization of Medigap policies, Minnesota does not. Minnesota is one of the three waiver states that standardized their Medicare supplement plans before NAIC’s involvement in 1990. Because of this, so long as the plans offered cover the basic requirements, Minnesota (along with Massachusetts and Wisconsin) is able to continue issuing their Medicare supplement plans.
Source: medicaresupplement.com

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September 06, 2013

Medicare Supplements (Medigap) For Dummies

Posted by:  :  Category: Medicare

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

Video: False Claims Act Lawyer Sterling Heights, MI (866)598-0941 Michigan Tax Fraud

Sterling Health Plans 2011

Does anyone know if Sterling Life is partnering up with FMO’s to offer plans for 2011? They have been a captive company for years. Also, are they pulling all of their plans out of Pennsylvania? I received this email today. (I left out the agency name that made the announcement) Thanks for any info you can give me.
Source: insurance-forums.net

Munich Re agrees to terms for acquisition of Windsor Health Group, Inc.

Munich Re stands for exceptional solution-based expertise, consistent risk management, financial stability and client proximity. This is how Munich Re creates value for clients, shareholders and staff. In the financial year 2009, the Group – which pursues an integrated business model consisting of insurance and reinsurance – achieved a profit of €2.56bn on premium income of around €41bn. It operates in all lines of insurance, with around 47,000 employees throughout the world. With premium income of around €25bn from reinsurance alone, it is one of the world’s leading reinsurers. Especially when clients require solutions for complex risks, Munich Re is a much sought-after risk carrier. The primary insurance operations are mainly concentrated in the ERGO Insurance Group. With premium income of over €17bn, ERGO is one of the largest insurance groups in Germany and Europe. 40 million clients in over 30 countries place their trust in the services and security it provides. In international healthcare business, Munich Re pools its insurance and reinsurance operations, as well as related services, under the Munich Health brand. Munich Re’s global investments amounting to €182bn are managed by MEAG, which also makes its competence available to private and institutional investors outside the Group.
Source: munichre.com

CPIDs 2161 and 1620 Guardian Healthcare No Longer Accepting Electronic Claims Effective 01/01/2012

Effective immediately, t he following payer will no longer accept electronic claims with dates of service on or after 01/01/2012: CPID 2161 Guardian Healthcare – Professional CPID 5975 Guardian Healthcare – Institutional Electronic claims with dates of service on or after 01/01/2012 must now be submitted to the following payer: CPID 6111 Sterling Medicare Advantage – Professional CPID 1620 Sterling Medicare Advantage – Institutional If you have already submitted electronic claims to Guardian Healthcare this year, those claims may have been rejected and will need to be submitted to Sterling Medicare Advantage. Please be sure to submit electronic claims to the correct payer. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

Sterling New Health First VP of Managed Care

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

‘North Colorado’ struggles to come together

That puts Moffat County in an unusual position, literally. Located in the northwest corner of the state, it shares no borders with any of the several other counties in the northeast whose residents will vote to break off from Colorado in November.
Source: dailycaller.com

Welcome The Proud Americans

As a national marketing organization our most significant strength is our reputation and relationship with insurance carriers that have a regional, national and global focus.  We have worked hard to achieve prominent positions with our insurance carriers.  These long term relationships enable us to better serve you and deliver services that are important to you.
Source: medicareadvantagespecialists.com

Sterling Health Insurance Company Review

Sterling Life prides itself on providing high quality personalized service to all its clients. The company motto is “Real People, Wise Choices.” The Sterling website provides a testimonial page featuring comments by current customers. Sterling members have access to an excellent interactive portal where they may file a claim, make a premium payment, download information and forms, or shop for a new insurance plan. Plans are available to fit the needs of any individual wherever they might live in the US.
Source: healthinsuranceproviders.com

Dallas Morning News Article

Soon after enrolling, the 73-year-old Dallas woman learned that doctors she had had for years didn’t participate in the plan. What most upset her, though, was that her prescription drug costs jumped by a couple of hundred dollars a month.
Source: medicaresupplementcenter.com

Medicare Plans That Broke Rules Include Familiar Names

Freedom Heath’s Chief Operating Officer Sidd Pagidipati said the company sends its agent-compensation plan to the Centers for Medicare and Medicaid Services (CMS) every year and has heard no objections. “In general, we, as a health plan, are very sensitive to protecting Medicare beneficiaries and their rights. In fact, we have secret shoppers attending 100% of our independent sales seminars.” Anyone who breaks rules goes through immediate retraining or gets fired, he said.
Source: kaiserhealthnews.org

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September 06, 2013

Dialysis costs challenge Medicare budget

Posted by:  :  Category: Medicare

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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

Video: The Story of Medicare: A Timeline

The Story of Medicare: A Timeline

Written and produced by Foundation staff, The Story of Medicare: A Timeline serves as a visual timeline of Medicare’s history, including the debate that led to its creation in 1965 and subsequent changes, such as the passage and repeal of the Medicare Catastrophic Coverage Act in the 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2012. The seven-minute video also highlights the program’s impact on the 50 million elderly and disabled Americans it serves today, as well as the fiscal challenges it faces to ensure its long-term sustainability.
Source: kff.org

History of Medicare Insolvency Predictions Since 1970

Only the Hospital Insurance (HI or Part A) has the potential of becoming insolvent. Medicare Part A is only considered “insolvent” when revenues and trust funds cannot cover 100% of the costs. Currently trustees predict that revenues and trust funds will only be able to cover 87% of Part A costs in 2026. It should be noted that trustees have consistently predicted such shortfalls since the program began. However, historically presidents and congresses have acted to adjust costs and revenues to keep the program at 100%.
Source: ramirezgroup.com

Medicare comes to Kaiser Permanente

Please do not include any medical, personal or confidential information in your comment. Conversation is strongly encouraged; however, Kaiser Permanente reserves the right to moderate comments on this blog as necessary to prevent medical, personal and confidential information from being posted on this site. In addition, Kaiser Permanente will remove all spam, personal attacks, profanity, and off topic commentary. Finally, we reserve the right to change the posting guidelines at any time, at our sole discretion.
Source: kaiserpermanentehistory.org

The History of Medicare in Seven Minute Video

The arrival of my 50th birthday is prompting me to post this zippy video about  Medicare. It  is written and produced by the Kaiser Family Foundation staff and serves as a visual timeline of Medicare’s history. It cleverly presents the debate that led to Medicare’s creation in 1965 and subsequent changes, such as the passage and repeal of the Medicare Catastrophic Coverage Act in the 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2012.
Source: chicagonow.com

History of medicare in Canada

By the time this shift in thinking occurred, decisions had been made about funding healthcare that set the pattern for the future. In terms of financing, many early reports assumed that some of the costs of medicare would be paid directly by patients or taxpayers. The 1939 Rowell-Sirois Report, which dealt with federal-provincial fiscal relations, assumed that contributions from employers and employees would raise most of the money. One of the intellectual architects of Canada’s social programs, Leonard Marsh, wrote in his 1943 report that there were “psychological” as well as financial benefits to having taxpayers pay a part of their healthcare costs. He linked the amount of coverage to the size of contribution made directly by individuals – that is, if more services were to be covered, then individuals would have to pay more directly from their pockets. Tom Kent, Prime Minister Lester B. Pearson’s key policy adviser when medicare was created in the 1960s, recommended that up to 25 per cent of healthcare costs should come from making healthcare a taxable benefit. Kent believed that there was a problem with healthcare being a “free good”. If even a small part of what patients and taxpayers paid for healthcare was related to their use of the system, there would be some restraint on the demand for services. Kent also knew that if medicare were to be funded solely from the general pool of taxes, governments would only be able to cover a narrow range of services.
Source: troymedia.com

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September 06, 2013

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

Posted by:  :  Category: Medicare

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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

Video: Law Book Review: Medicare Handbook 2012 Edition by Judith A Stein, Alfred J. Chiplin Jr.

Get the Official 2013 Medicare Handbook

official US government Medicare handbook  for 2013 by clicking here. Learn about new benefits available to seniors in 2013 under the Affordable Care Act (Obamacare), including more coverage for preventive services and lower prescription drug costs. You can also find out more about how Medicare works, determine whether a particular test or service is covered by Medicare, and verify your 2013 Medicare copays and deductibles.
Source: themeadfirmllc.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

Medicare Officials Tell Beneficiaries to Stay Away From Exchanges

The 2014 “Medicare & You” handbook that 52 million beneficiaries will receive next month will explain Medicare beneficiaries don’t need to bother with the exchanges, according to the report. Although seniors could opt to sign up for plans through the marketplaces, they wouldn’t qualify for premium tax credits. Additionally, Medicare coverage offers better benefits and is more affordable for most beneficiaries, according to the report.
Source: beckershospitalreview.com

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September 06, 2013

Medicare Fee Schedules Must Be Disclosed in PIP Policies

Posted by:  :  Category: Medicare

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This issue was certified to the Florida Supreme Court by the Third District Court of Appeals (“3rd DCA”) after noticing that similar issues were being raised in Florida courts statewide. The initial decision by the 3rd DCA was consistent with the other districts which have already decided on such issues. The Florida Supreme Court decision affirmed the decisions of all the DCAs that PIP insurance providers must notify policyholders by an election in their policy if they plan to use Medicare-based fee schedules.
Source: flpipguide.com

Video: WILL MEDICARE PAY YOUR DOCTORS AFTER YOU’RE INJURED IN A FL ACCIDENT?

Former Office Manager for Health Care Solutions Network Sentenced in $63 Million Medicare Fraud

Court documents reveal that Palmero was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the fabrication of medical records by preparing, and causing others to prepare, documentation that was later utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.
Source: sandpointpr.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

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 06, 2013

How will the Affordable Care Act affect Medicaid in Pa., N.J. and Del.?

Posted by:  :  Category: Medicare

• Pennsylvania has not signed on for an expansion. Generally speaking and setting aside special situations such as domestic violence that could make a person eligible for the program, the current income eligibility for a childless adult or a parent is about $5,500 a year (or 47 percent of the federal poverty level). Consumer advocates and state officials are concerned that most of those individuals who would be eligible for Medicaid under an expansion (an estimated 600,000 by their count) will be left to buy insurance on the private market without any sort of financial assistance.
Source: newsworks.org

Video: New Jersey Medicare Supplements

Home Care Services in Nutley, NJ Medicare

Whether it’s in business or in life, finding the right partner is vital to the success of any union.Fortunately, Zack and Phyllis Demopoulos have found the perfect counterparts in each other.After 21 years of marriage, the couple decided to join forces in a new way with ComForcare.Zack had over two decades in healthcare at Warner-Lambert and Pfizer, and Phyllis was a stay-at-home mom of three and former Estée Lauder trainer.Their strong family values and personal experience with helping relatives who required continuous assistance led them to a business centered on providing top-notch care to those needing it most. ComForcare is committed to providing caregiving, resources and education to families in Northern Essex and Southern Passaic counties. Google
Source: inhomecarecaldwell.com

Medicare Open Enrollment in NJ and PA

David brings over 12 years of experience in health insurance advocacy and coordination. David previously served in a supervisory capacity including acting director with the Camden County Department of Health and Human Services, Division of Senior and Disabled Services. David also was the coordinator of the State Health Insurance Assistance Program (S.H.I.P.) and a certified counselor assisting in the education and implementation of Medicare, supplemental health insurance and prescription drug coverage to the senior and disabled population.
Source: rothkofflaw.com

Medicare billing discrepancies used to convict New Jersey doctor

Medicare billing codes indicated the doctor provided services that should have taken up to 2.5 hours to perform. The physician allegedly did not spend the required time with in-home senior patients but billed the government as if she did. Government attorneys said the fraudulent practices made the woman the state’s highest billing home health care physician from 2008 to 2011.
Source: stahlesq.com

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

Workers’ Compensation: NJ Court Approves Medicare Set

“The court has thoroughly reviewed the sworn testimony of plaintiffs’ expert regarding the proposed set-aside amounts for future medical expenses relating to the underlying accidents/incidents, which would otherwise be covered or reimbursable by Medicare. The court finds that the proposed set-aside amount in each case fairly takes Medicare’s interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare’s interests have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the proposed sums in self-administered interest-bearing accounts to be used solely for the purpose of satisfying future medical expenses related to the underlying accidents/incidents.” DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, — A.3d —-, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
Source: blogspot.com

Corrected: New Jersey’s Christie vetoes Medicaid expansion bill

The vetoed bill would have removed the flexibility to opt out of the Medicaid expansion if the federal government changed the terms of the current favorable matching rate, the spokesman said. The governor had discussed publicly his intention to maintain this flexibility when he signed onto the expansion, the spokesman said.
Source: rawstory.com

Government presses therapy provider to repay $3 million in Medicare reimbursements

The OIG audit looked at Medicare Part B claims that Spectrum Rehabilitation LLC filed in 2009 and 2010. Out of 100 representative claims, 83 did not comply with Medicare requirements, according to the audit report. The deficiencies were varied, including medically unnecessary therapy, inadequate treatment notes and physician certification issues, the report states. More than half the claims contained more than one deficiency. 
Source: mcknights.com

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