How to File a Medicare Appeal

Posted by:  :  Category: Medicare

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If you are thinking about filing an appeal, talk to your doctor, health care provider or supplier. Ask them to provide any information that will support your appeal. Read your plan materials or contact your insurance agent or plan for details about your appeal rights. Medicare and all companies that provide Medicare Advantage plans are required to help you file an appeal.
Source: mutskoinsurance.com

Video: AT Network Training on AT and Medicare

Advocates Head To Court To Overturn Medicare Rules For Observation Care

When seniors call Medicare to complain about observation status, the option to appeal is rarely mentioned. According to records of 316 complaints — the total Medicare said it received from beneficiaries or their representatives about observation since 2008 — a typical response was that Medicare “cannot intercede with hospital/physician regarding change of status.” In a response to one of dozens of congressional inquiries, officials “advised senators [Center for Medicare and Medicaid Services] cannot change a hospital stay classification.”
Source: kaiserhealthnews.org

How to Appeal a Medicare Decision

Although we won’t go through all five steps of an appeal process, we can describe the first step. How you file an appeal depends on the type of Medicare coverage you have. But no matter what type of Medicare plan you have, at any step of the appeals process, you can—and may want to—ask your doctor, health care provider or supplier for any information that may help your case, or other help.
Source: northwestbenefitssolutions.com

Your legal rights: Know your hospital rights

For example, “Jane” was taken to the hospital after a fall. A doctor reviewed her x-rays and informed her that she had a sprained knee.  Jane was not able to stand with a brace, so she was sent to a hospital room. Another doctor wanted to take a CT scan of her knee, but she asked to wait until the next morning because she was in pain.  The next day, the CT scan showed that she had a fracture.  Jane assumed that she had been admitted as an inpatient.  No one told her that she was coded as “observation status.” After spending three nights in the hospital, Jane was discharged to a skilled nursing facility for rehabilitation.  Because of the “observation status” classification while at the hospital, Medicare Part A did not cover the costs of her stay at either the hospital or the nursing facility. Jane was billed more than $11,000 for her stay at the hospital and almost $16,000 for services at the nursing facility.
Source: hometownargus.com

Facts About the Medicare Payment Denial Appeals Process

CMS contracts with private insurance companies to perform many functions on behalf of the Medicare program, including processing claims for Medicare payment and carrying out the first level of the Medicare claims appeals process. Historically, these companies have been known as fiscal intermediaries (FIs) for Part A services and carriers for Part B services; however, as directed by section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, both Part A and B work is being integrated under new entities called Medicare Administrative Contractors (MACs). For more information on MAC implementation, see: http://www.cms.hhs.gov/MedicareContractingReform.
Source: homehealthnews.org

Does the Medicare Appeal Process Take Too Long?

Paula Oertel used an unapproved drugs for nine years to treat a brain tumor, and Medicare paid for it. When Oertel moved in 2007, she temporarily lost her Medicare coverage, and she went without treatment. During that time, two different drugs were approved to treat her condition. Once Oertel regained her Medicare coverage, both drugs were used, but neither worked. When the doctors tried to prescribe interferon, her claim was rejected by Medicare.
Source: elderparenthelp.com

The other Washington could hold the key to Medicare's cost crisis

 But in Washington state, which is known for its progressive politics, the measure, requested by former Democratic Gov. Christine Gregoire, sailed through the legislature, albeit with an appeals process amendment the governor vetoed. “Medicare should be doing this, but it gets rolled by the Congress,” said Dr. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission (MEDPAC), an independent agency that advises Congress on issues affecting Medicare. Berenson pointed to several high-profile examples of Congress meddling with coverage policy, including the case of the late Sen. Ted Stevens of Alaska, who at the behest of the PET scan industry almost single-handedly forced Medicare to cover the scan as a test for Alzheimer’s, a policy that existing science did not support.
Source: publicintegrity.org

Medicare: Help with Discharge Appeals

A call is all that’s needed to get the ball rolling. If you do not reach someone during business hours, leave a message on the Q.I.O. phone line, and staff members will begin working on your case the next day. They will ask that your medical record be faxed (it’s required that the records be sent by the close of business on the day of the Q.I.O.’s request), forward that record on to an independent medical reviewer, and resolve the appeal within one day of receipt of that record.
Source: awareofyourcare.com

No more Medicare Advantage leads

Posted by:  :  Category: Medicare

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The carriers will love all of this because it puts everyone on an equal playing field and drives everyone in through their telemarketing and bypasses the agents which they also love to do. Some zamboni of the phone slams them into an MA and an hour later they dont know what the hell they have or who to call about it. I suppose it is also a windfall for captive agents who get some feed off the tv ads and mailings and not have to compete with the independents at the local buffet. However, after next enrollment season, the entire field looks grim for them too. This bill only address how to market. Other legislation will address whether they will be offered at all. The PFFS piece has already taken a fatal hit. As with the PFFS plans, congress will probably not kill MA’s but cut their subsidies and then tell the carriers to do what they want. Then when the carriers raise their rates to cover costs or failure to realize savings then the public will just say "what the hell, I can get a full med supp without the smoke and mirrors of an MA for another fifty bucks a month beyond what the MA would cost me." Winter
Source: insurance-forums.net

Video: CHEAP MEDICARE ADVANTAGE (MAPD) LEADS

Medicare Advantage Leads for Sale

Over the past month we have been mailing for medicare advantage and have received thousands of medicare advantage leads all of them are in upstate new york. Unfortunately the parter in our company that had the NY license is no longer working for us and we are STUCK with leads we can’t sell medicare advantage to. These are real leads – you’ll get a copy of the response card 95% of them have phone numbers on them permitting you to call them to setup an appointment. These leads cost us tens of thousands of dollars and I need to get rid of them. Please PM me if you are interested. I’ll only sell them in blocks: 5 leads as a sample $75 25 = $12/ea 50 = $10/ea 100= $9/ea 250=$8.50/ea 1000+=$6/ea You can pay for the samples with paypal, all others must be via company check. I’ll even credit back the $75 for a bulk order. This isn’t a scam, I’m desperate to get rid of these hot leads. I hate to see them go but I would hate to have the respondents not get anyone sending them information. I’ve called around to lead companies but I keep getting disconnected numbers! So I am only selling them here and will only sell them once. Please PM me with the companies you represent and the amount of leads you are interested in.
Source: insurance-forums.net

Kathleen Sebelius extends Medicare Advantage to same

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” Sebelius said in a statement.  “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”
Source: washingtonexaminer.com

Possible Medicare Advantage Pay Reductions Cause Insurer Stocks To Slip

Modern Healthcare: Insurers See Proposed Medicare Advantage Rates Hitting Revenue Health insurance companies are expecting reduced Medicare Advantage payments to unfavorably impact revenue next year. The CMS on Friday released its proposed 2014 rates for Medicare Advantage plans, prompting negative reaction from payers and investors. Shares of health insurance plans such as Humana, Universal American Corp. and Health Net took a dive on the news when they opened for trading this morning. The CMS proposal calls for a 2.2% decline in Medicare Advantage benchmark payment rates. Humana, which derives most of its revenue from Medicare Advantage, saw one of the largest decreases in its share price (Kutscher, 2/19).
Source: kaiserhealthnews.org

Why Medicare Advantage Sales Leads will be King in 2009

To view our online lead portal, simply register at our AGENT GATEWAY.  You can record lead information, track statuses, update dispositions, next step dates, appointment dates, sales dates, product sold, company sold, etc.  This is a free service to you and this is why many Insurance Companies are looking to Ritter Insurance Marketing to handle the distribution of their Sales Leads to brokers who are licensed with Ritter Insurance Marketing!
Source: ritterim.com

RealTime Medicare Advantage Insurance Leads

Competition is tougher when you know that every other agent is clamoring to seal the deal with the same clients that you go after to. But if are a goal-driven entrepreneur who is ready to face any challenges along the way, you would be surprised to know that there is a new set of online users that is making waves in the insurance market today.
Source: realtime-insuranceleads.com

Too Many Medicare Advantage Choices Can Decrease Enrollment

To examine the effects of multiple plan options on enrollment in Medicare Advantage, the authors looked at 21,815 enrollment decisions from 2004 to 2007 made by 6,672 participants in the Health and Retirement Study, a national longitudinal survey conducted biennially by the University of Michigan. They found that if fifteen or fewer plans were available in a region, more choices usually led to an increase in Medicare Advantage enrollment. When the number of options surpassed thirty, as it did in 25 percent of US counties, more choice was associated with decreased enrollment in the program.
Source: healthaffairs.org

What happened to Highmark Medicare Services?

Posted by:  :  Category: Medicare

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Video: Pittsburgh Celebrates Medicare’s Anniversary

Highmark will pay doctors higher rates if they keep patients out of the hospital

Highmark’s alliance, which includes six Allegheny Health Network hospitals around Pittsburgh and about 500 primary care physicians, will pay doctors bonuses for performing specific activities for which they aren’t reimbursed but can keep patients’ illnesses from getting out of control. Some examples, Kaplan said, are coordinating with the colleagues to avoid duplicating tests and following up with patients with chronic diseases to make sure they’re taking medications regularly.
Source: medcitynews.com

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark gets Medicare contract for seven more states

Under the five-year contract, the company will handle both Medicare Part A and Part B fee-for-service claims for hospitals, physicians and other healthcare practitioners in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas, according to a Highmark Medicare Services news release. It already serves as the Medicare administrative contractor for Delaware, Maryland, New Jersey, Pennsylvania and Washington, D.C. Highmark Medicare Services has offices in Camp Hill, Pittsburgh and Williamsport, Pa., and in Hunt Valley, Md., and is a wholly owned subsidiary of Highmark, which is a Pittsburgh-based licensee of the Blue Cross and Blue Shield Association. The company recently reached an agreement to acquire West Penn Allegheny Health System, a struggling five-hospital system based in Pittsburgh.
Source: modernhealthcare.com

Highmark lands Medicare contract that could create jobs in the Harrisburg area

The contract involves processing Medicare claims for a region that includes Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado and New Mexico. Highmark already has an identical contact for claims from Pennsylvania, New Jersey, Maryland, Delaware and the District of Columbia.
Source: pennlive.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Avoid Medical Practice Productivity Loss Due to ICD

Some see ICD-10 implementation as an obstacle, but it’s really a chance to improve your healthcare business skills and knowledge. Certainly there will be a learning curve with ICD-10. Codes are very different, guidelines have changed in some spots, and physician documentation needs to be more precise. You will undoubtedly need to learn the new guidelines and coding processes quickly. However, these are manageable tasks, provided you start preparing now. Failure to prepare early enough will result in lost productivity. There are many ways the ICD-10 implementation will affect productivity. The largest and most obvious area is provider documentation. Whenever documentation lacks certain specific elements, which are required for accurate and precise code selection, a query for additional information will need to go to the provider. If the physician is not immediately available, the service can’t be billed until clarifying information is received. Another potential productivity challenge with documentation involves charge tickets, or “superbills.” These forms may become obsolete in ICD-10 because there will be more code choices in some fields. If the provider does not understand what is required to differentiate between the new codes, documentation will likely be insufficient. Medical coders and physicians should begin training now to reduce potential productivity loss. Procrastinating will only result in extensive educational needs right before or immediately following the ICD-10 transition. At the very least, this would result in time away from work during the most stressful part of implementation. Coders should devote roughly 20 hours to 40 hours of training to ICD-10 education prior to the transition. Physicians should plan on about eight hours to 16 hours of ICD-10 training. In all likelihood, productivity will not return to normal after implementation. There will be an inevitable delay as assessments are made of how the payers are interpreting the new coding system. Each payment and remittance advice will need to be scrutinized to make sure claims have been correctly processed and, whenever extra information is needed, it should be sent in a timely fashion. Recurring deficiencies must be identified and rectified as soon as possible. Current diagnosis codes are mostly numeric (V and E codes are the exception), but ICD-10 codes are alphanumeric. Entering new codes will single-handedly slow productivity because a number keypad will not be exclusively used to do so anymore. In addition, distinguishing between letters and numbers will take extra time when a diagnosis code is written (as opposed to a narrative description). Depending on penmanship, which is not stereotypically a common strength for most physicians, the number “2” may be mistaken for the letter “Z,” or the number “0” for the letter “O.” It is crucial to start raising provider awareness regarding how documentation will be specifically affected by ICD-10, and to encourage providers to quickly become familiar with the specificity of their specialties. Doing so will allow enough time for providers to understand the requirements, so ICD-10 will not feel like a massive change all at once. Assuming the practice has anticipated, learned, and prepared for the changes and potential setbacks, productivity should return to normal within about four to six months after ICD-10 implementation. In such circumstances, the practice’s bottom line will be only minimally affected. For any office that waits until the last minute to prepare for the transition, or simply relies too much on outside sources (i.e., EHR vendor, billing company, etc.), the staff will be constantly striving to catch up. Seeing an increase in claim denials, such practices may not be able to remediate the situation because the staff doesn’t understand the guidelines. Awareness and timing are critical to minimizing the negative impact on a practice’s productivity. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, AAPC vice president of ICD-10 education and training, has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for healthcare publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation workgroup and has provided ongoing testimony for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).
Source: physicianspractice.com

CMS National Training Program Medicare Workshop 2013

Posted by:  :  Category: Medicare

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September 10-11, 2013 Doubletree by Hilton Buckhead Atlanta, GA The 2013 CMS National Training Program Workshop is offering free CMS training. What will be presented this year: • Both high-level and detailed information about key aspects of the Medicare program • A half-day basic track for those who are new to Medicare or who want a refresher • A “Current Topics” session to raise awareness of program changes • An introduction to the new Health Insurance Marketplace • Casework exercises • Medicare training modules and workbooks • Networking opportunities with CMS staff and other partners who share your commitment More information on program and logistics available soon, including information to book hotel accommodations at the group rate. This session does not fulfill the certification requirements for Navigators or other assisters, or for agents and brokers. The training that does provide certification for the Marketplace will be web based and be accessible in August. NOTE: Registration requests will be considered on a first come, first served basis until each meeting reaches capacity. The number of attendees from the same organization may be limited.
Source: gaobgyn.com

Video: Medicare Supplement Insurance Statesboro Ga Call Now 912-764-1146

H.R.2619: Medicare Respiratory Therapist Access Act of 2013

Official: To amend title XVIII of the Social Security Act to provide for Medicare coverage of pulmonary self-management education and training services furnished by a qualified respiratory therapist in a physician practice. as introduced.
Source: opencongress.org

Georgia, South Carolina not expanding Medicaid

“For the provisions of the Affordable Care Act related to health insurance coverage, CBO and JCT’s latest estimates are quite similar to the estimates we released when the legislation was being considered in March 2010. The following figure shows CBO and JCT’s projections of the effects of the ACA on the number of people who will be uninsured or will receive insurance coverage through employer-sponsored insurance (ESI), insurance exchanges, or Medicaid or the Children’s Health Insurance Program (CHIP). Although the latest projections extend the original ones by three years (corresponding to the shift in the regular 10-year projection period since the ACA was first being developed), the projections for each given year have changed little, on net, since March 2010.”
Source: augusta.com

Medicare Facts: GA Gov. Nathan Deal Taking Payola To Obstruct Obamacare

Let’s also pay attention to the Big Donors here: United Health, Aetna, Humana and Blue Cross. United Health and Aetna have declined to participate in state-based exchanges in states where they’re actually
Source: blogspot.com

Augusta needs Medicaid expansion, and so does Georgia

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

Reimbursing Medicare; statute of limitations clarified

The SMART Act which becomes affective on October 10, 2013, clarifies the uncertainty surrounding the statute of limitations governing MSP claims, establishing a three-year statute of limitations from the date of notice of a settlement, judgment, award, or payment. Prior to the SMART ACT, it was unclear whether the government had three or six years within which to bring a recovery action. For example, in United States v. Stricker, No. 9-2423 (N.D. Al. filed Dec. 1, 2009), the court looked to the statute of limitations in the Federal Claims Collection Act, 28 U.S.C. § 2415, and applied the three-year statute of limitations for tort claims against corporate defendants and the six-year statute of limitations for contract claims brought against attorneys who represented claimants in the underlying tort litigation. The statute of limitations applies to actions brought and penalties sought on or after six (6) months from January 10, 2013, the date of enactment.
Source: warnerrobinspersonalinjuryblog.com

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

Should I Shop Multiple GA Medicare Supplement Carriers?

One of the most important things to consider is this;  Medicare Supplement (Medigap) insurance companies in Georgia can only sell you a “Standardized” policy identified by the letters A through N. Each standardized Medigap or Medicare Supplement policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter name. In other words, a Plan F from one company has the same benefits as the Plan F from a completely different company, but the premiums may be vastly different for the exact same product! This is why it is so important to shop all of the carriers who offer
Source: gahealthplans.com

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

Enrollment Begins Oct. 1 for Coverage of Basic Health Care

To help people like the Quigleys navigate the marketplace, AARP Georgia staff and trained volunteers are attending health fairs and other community events to help get the word out about the exchange and how to enroll. AARP also will host a tele-town hall Oct. 10 and will send emails about the exchange to about 150,000 Georgians.
Source: aarp.org

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September 07, 2013

Reed Tinsley, CPA: Major Improvements to the Internet

Posted by:  :  Category: Medicare

The provider/supplier can access the enrollment information from the My Enrollment page. The information will display in an HTML view and can be saved and/or printed by the provider/supplier. Note: The CMS-855 PDF forms are no longer available and have been replaced with the new HTML views. The enrollment tutorial videos, located on the PECOS home page, have been updated to illustrate the most common enrollment scenarios completed by providers/suppliers. A new part B provider service has been established for Centralized Flu Billers. In addition, the Centralized Flu Biller Approval letter has been added as a type of Required/Supporting documentation for a CMS 855B enrollment. Centralized Flu Biller enrollments submitted via PECOS will be routed to Novitas Solutions, the designated Medicare Administrative Contractor (MAC) responsible for enrolling this provider service. A new “Durable Medical Equipment (DME) License Information” topic has been added to PECOS. This topic will display the DME license information currently on file for existing suppliers. The information is viewable only and cannot be edited or deleted by the supplier.
Source: blogs.com

Video: CMS MEDICARE AND PECOS PROVIDER ENROLLMENT .wmv

Medicare PECOS Update: Denials Will Begin May 1, 2013!

The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Source: rtwelter.com

OIG: PECOS, NPPES data 'inaccurate'

The OIG recommends that CMS implement program integrity safeguards for Medicare provider enrollment, require more verification of enrollment data, and better detect and correct inaccurate and incomplete data for new and established records, according to the release. CMS concurred with all three recommendations.
Source: hmenews.com

PECOS: A Medicare Benefit for your Practice

Henderson Medical Billing Solutions LLC is an outsourced Medial Billing and Practice Management service located in Murrieta, California.  Henderson Medical Billing Solutions provides medical billing services to solo providers to mid-level practices throughout the United States.  Henderson Medical Billing Solutions offers Full Practice Management, Medical Billing, HIPAA Compliance Auditing and Training to medical and non-medical providers.  In addition, Henderson Medical Billing Solutions offers Accounts Receivables Recovery and New Practice Start-Up services.  Our staff includes certified practice managers and billers who are committed to the success of increasing provider revenue reimbursement.  To learn more about how we can maximize revenue and increase your practices productivity Contact us today.
Source: hendersonmbs.com

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September 07, 2013

Medicare gives Texas hospital 90 days to shape up

Posted by:  :  Category: Medicare

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The agency gave the hospital until Oct. 6 to fix the problems or lose funding. “We’ve still got work to do, and that’s our focus,” said Carrie Williams, spokeswoman for the Texas Department of State Health Services, which operates state hospitals. “The extra time will let us continue to work on the hospital, make improvements and meet the standards we expect from our state hospitals.” The Medicare agency was expected to reveal its detailed findings at the end of the month after the state has a Medicare-approved plan to remedy the hospital’s shortcomings, the American-Statesman reported. The investigation began in April after the American-Statesman made the agency aware of the 2012 death of Terrell State Hospital patient Ann Simmons. The 62-year-old woman died at the hospital 30 miles east of Dallas after being left in restraints for 55 hours. Medicare investigators concluded that improper care was responsible for her death and a continued threat to the lives of other patients. After warning the state of urgent deficiencies, which the state has remedied, the Medicare agency began a comprehensive investigation of the hospital. The agency’s letter stemmed from that investigation, the American-Statesman reported. Since April, state officials have forced the hospital’s superintendent to resign and closed its 20-bed medical unit.
Source: modernhealthcare.com

Video: What Are The Differences Between Medicare and Texas Medicaid

Who Pays For Hospice Care In Texas?

Medicare—If a person is terminally ill and is a Medicare beneficiary using a Medicare-certified hospice provider, 100 percent of hospice services are covered. In 2011, 84.1 percent of hospice patients were covered by the Medicare hospice benefit.  Hospice payments are separate from Medicare payments for other illnesses, diseases or care the patient may be receiving. 
Source: cbslocal.com

Texas SMP Medicare Scam Workshop

Crockett Resource Center for Independent Living (CRCIL) will be hosting a workshop about the Senior Medical Patrol Project (SMP) on Thursday, August 29th, 2013 at 10:00 a.m.  Presenter, Rick Rameriz, Texas SMP Project Coordinator, reports that there are many different ways Medicare is defrauded and each year, billions of dollars are stolen by scam artists and crooks.  The SMP presentation will educate seniors on how to protect, detect, and report fraud, waste, and abuse of the Medicare system.
Source: countylifeonline.com

Texas Health Resources, physician group withdraw from Medicare’s Pioneer ACO program

The hospital and North Texas Specialty Physicians are partners in Plus ACO, an accountable care organization that joined the Medicare Pioneer ACO program in December 2011. Accountable care organizations are intended to accept financial responsibility for Medicare beneficiaries’ healthcare and share in any losses or savings their patients accrue.
Source: medcitynews.com

Texas man sentenced for Medicare scam

Prosecutors say Kimble operated four ambulance companies in the Houston area from 2008 to 2010. He routinely billed the federal Medicare program for ambulance transports that were not provided, not needed or not ordered by a treating physician.
Source: ems1.com

Ways to prevent Medicare fraud in Texas before it occurs

Strong evidence indicates that isolated pockets of home health providers are abusing the Medicare program. Analyses show, as detailed in your article, Texas is home to high levels of aberrant behaviors. In fact, just 18 of Texas’ 254 counties are responsible for more suspected home health fraud and abuse than any single state nationwide.
Source: dallasnews.com

MedicareBob’s Blog: Bexar County Texas Medicare Supplement Quotes

                   Bexar County Texas                         Zip Code:   
Source: blogspot.com

Bexar County Texas Medicare Supplement Quotes

Tagged With: Aetna Medicare, Aflac Medicare, Bache, Bexar County Medicare, Bexar County Medicare Supplement Insurance, Bexar County Texas Medicare Supplement Insurance, Cigna Medicare, Medicare, Medicare Quotes, MedicareBob, Medigap, Mutual of Omaha Medicare, Robert Bache, Senior Healthcare Direct, Texas Medicare, www.SrHealthcareDirect.com
Source: srhealthcaredirect.com

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September 07, 2013

State Highlights: Fort Worth To Move Retirees Into Medicare Advantage Plans

Posted by:  :  Category: Medicare

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Los Angeles Times: Patient-Interpreter Bill Aims To Overcome Language Barriers According to a 2012 study prepared for the federal Agency for Healthcare Research and Quality, pediatric patients with limited-English-proficient families who speak Spanish “have a much greater risk for serious medical events during hospitalizations than patients whose families are English-proficient” … [A bill that would make a statewide medical-interpretation program available to Medi-Cal patients] would require the state Department of Health Care Services to apply for federal money that would pay for a certified medical-interpreter program. Such a program is needed, supporters say, to prepare hospitals for the millions of limited-English speakers expected to use healthcare services over the next few years (Kumeh, 8/18).
Source: kaiserhealthnews.org

Video: News – Medicare Advantage, Jordan, South Korea, Shanghai Shanghai

HHS Expands Medicare Advantage Coverage for Same

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said CMS Administrator Marilyn Tavenner in the release.  “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”
Source: beckershospitalreview.com

Top 5 Medicare Questions Asked By Seniors

Eligible individuals have the opportunity to enroll in or make changes to their Medicare Advantage and/or Part D Prescription Drug Plan during the Annual Enrollment Period, which runs from October 15 to December 7 of each year. Medicare Advantage plans must offer at least the same coverage as Original Medicare (Part A and Part B) and may include additional benefits. Stand-alone Part D plans provide coverage for eligible prescription drug costs. Another type of coverage that beneficiaries may be interested is a Medicare Supplement plan, which fills in the gaps in coverage left behind by Original Medicare. However, the best time to enroll in these plans is when you are first eligible and not necessarily during AEP. If you are looking for more information regarding the differences between MA and Medicare Supplement plans, check out this blog post. If you are trying to choose between Original Medicare and enrolling in a Medicare Advantage plan, this post may be helpful.
Source: planprescriber.com

New Medicare guidance guarantees that same

Private Medicare plans must provide coverage so that married couples that are eligible for skilled nursing facility benefits can reside in the same SNF, according to the Department of Health and Human Services. This applies to same-sex as well as opposite-sex couples, according to a memorandum issued yesterday. The guidance applies to all legally married couples, “regardless of where they live.”
Source: mcknights.com

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September 07, 2013

How Do I Obtain A Replacement Medicare Card?

Posted by:  :  Category: Medicare

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

Video: How Do I Get a New Medicare Card if my Card is Damaged, Lost, or Stolen?

Medicare allows for replacement of oxygen equipment if supplier leaves

In those instances, the oxygen equipment will be considered lost and a new 36-month rental period and reasonable useful lifetime will begin for the new supplier furnishing replacement oxygen equipment, on the date that the replacement equipment is furnished to the beneficiary.
Source: alpha-1foundation.org

Replacing Your Vital Documents

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

Medicare Cards Pose a High Risk for Identity Theft Scams

However, the Social Security Administration (SSA) recently made a request for the Centers for Medicare and Medicaid Services (CMS) to take immediate action to issue new cards to beneficiaries. These new cards would not have the individual’s Social Security number printed on them. (See: References 2) This is according to a report by the New York Times. (See: References 2) It was also noted that most private insurance agencies have stopped printing Social Security numbers on their beneficiary identification cards. This is due to the fact that many states have forbidden the inclusion of such personal data, according to the Times. But the SSA doesn’t have the authority to prohibit CMS from placing Social Security numbers on beneficiary Medicare cards. However, Congress does have that authority, according to the N.Y. Times.
Source: bestidentityprotection.net

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September 07, 2013

Medicare Fact Sheets for Professionals: Medicare Information

Posted by:  :  Category: Medicare

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“I want to compliment your organization on the quality of the fact sheets and informational materials on your website. I think they are among the most accurate and clearly written materials on Medicare (and Medi-Cal) available anywhere.”
Source: cahealthadvocates.org

Video: A Permanent Fix for Medicare – Know the Facts

Get The Facts First Medicare Supplement Insurance Medigap

Since Medicare supplement insurance is meant to help Medicare recipients, it should come as no surprise to learn that these insurance policies are restricted to people who meet their requirements. First and foremost, eligible Medicare recipients must be signed up for Parts A and B of Medicare. Each eligible Medicare recipient has an open enrollment period that lasts for six months. The period begins as soon as the eligible Medicare recipient reaches 65 and enrolls in Plan B of Medicare. During the open enrollment period, eligible Medicare recipients can enroll in a supplement without undergoing medical screening. It is important to remember that private insurance companies are not required to sell these insurance policies to Medicare recipients under 65, though the exact rules are not the same from state to state. For example, 25 states require private insurance companies to sell such insurance policies to all Medicare recipients, while other states might demand the same for smaller subsets of Medicare recipients. In most cases if you are under 65 and have Medicare A and B, the Medicare supplement would be a very expensive option as most carriers charge a great deal to get the coverage if you are under 65. However, Medicare Advantage plans could be available for such people.
Source: easytoinsureme.com

Does Australia have universal health care? > Check the facts

The media plays an important role in alerting voters to the existence of some problems, and in turn politicians are keen to influence the media’s reporting, but ultimately it is up to voters to decide on which issues are most important to them. In the lead up to the Federal Election, Facts Fight Back will provide a timely and accessible source of information to help voters, journalists and the politicians themselves keep track of who is sticking to the facts.
Source: org.au

“Obamacare” and Its Impact on Medicare: Separating Fact from Fiction

Change in payments to Medicare Advantage plans. Medicare Advantage plans have consistently cost the government more than traditional Medicare, averaging 14 percent more than traditional Medicare in 2009. Under the Affordable Care Act, the excess payments to private plans will be reduced to two percent while also providing financial incentives for plans to focus on providing high-quality care to enrollees. This should lead to better, more economically efficient care.
Source: principal.com

3 Facts About Medicare Supplemental Insurance

It always seems that Medicare Supplement Insurance is a big topic that has been floating around. The hard part is that not everyone is getting the correct information about this coverage. With so much information being thrown left and right about it, the false can get mixed up with the truth very easily. Here are three facts about Medicare Supplement Insurance.Lets talk about the first fact which is that medicare insurance will stay the same no matter who,what,where,when, and how you bought it and who you bought it for. This insurance coverage was made to help fill any gaps that were in the coverage previously. With that in your mind, they also made about twelve different levels worth of benefits. Making sure that it could fit everywhere. While there are many different levels the coverage will always stay the same no matter who you buy it from. If you are told otherwise, they are just trying to mislead you with a purpose.Secondly, the cost of medicare supplement insurance will vary depending on where you bought it from. Although you will always be getting the same coverage no matter where you buy the plan, the plan may differ in pricing itself. So whether it is a Florida Medicare supplement or a Medicare supplement policy from Georgia, the coverage will be identical (unless you live in Wisconsin, Minnesota, or Massachusetts, where they have adopted their own plans). It is solely up to the insurance company you plan on buying it from to give you the price they want to sell it for. The biggest suggestion is to always shop around before jumping towards one company instantly.
Source: wastedenergy.net

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September 07, 2013

Have you had a Medicare Supplement Rate Increase Recently?

Posted by:  :  Category: Medicare

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: Medicare Supplements vs. Medicare Advantage – Understanding Medicare Supplements

Medicare Supplement OR Medicare Advantage Plan, which is better?

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

Do I need a Medicare Supplement?

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

Work Your Exclusive Medicare Supplement Leads With The Right Tools

Use relationship marketing when dealing with exclusive Medicare supplement leads. Call your leads right away, introduce yourself, ask how else you may be of service, offer to send them articles you have written about the type of insurance they are interested in, help them focus on ways to get the kind of coverage they need and want. Be the expert. Be friendly and approachable, knowledgeable, make complex language easy to understand and just be you, because you are your most powerful marketing tool.
Source: benepath.net

Medicare and Health Insurance, What is Covered, Medicare Supplement

Medicare Part D pays for prescription drugs. This plan covers both generic and brand name prescription drugs. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year during the open enrollment period, you have the option to change your drug plan to fit your specific needs. Perhaps when you turned 65 you did not have need for extensive coverage, but as you get older and your needs change, this coverage can be increased as necessary.
Source: bradeninsurance.com

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

The Ins and Outs of Medicare Supplemental Insurance

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.
Source: insideeldercare.com

Bloomfield's News on Money

First of all, it’s important to understand that any Medigap policy which would fall under the Medicare supplement quotes is going to be regulated and standardized by the government. The federal and state laws which are in place are put there to protect you in a variety of different ways. For example, any policy that works along with Medicare must be identified as such and will carry the term “Medicare supplement insurance” along with it. In most states in the United States, the Medigap policies that are available are going to offer the same basic benefits, although there may be additional benefits that are offered under some policies. Those are the things that should be considered when looking for Medicare supplement quotes.
Source: bloomfieldnm.info

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

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

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

When a Medicare enrollee purchases a Medicare supplement Plan N they are making a commitment to participate in their healthcare costs, while still maintaining their freedom to use the services of any physician or hospital. Plan N requires the insured to pay their annual Medicare Part B deductible, up to a $20 physician’s office co-pay, a $50 emergency room co-pay unless admitted to the hospital and any excess charges over and above the Medicare approved charge. One should note that Medicare excess charges very rarely even exist as almost all physicians and hospitals accept the Medicare approved charge as full payment. This is called Medicare assignment and the consumer can contact their physician’s insurance billing office to confirm that they accept assignment and are considered a “participating” provider. Healthy, typically younger Medicare enrollee’s see Medicare supplement Plan N is a viable alternative to a Medicare Advantage plan. Medicare supplement Plan N offers substantially reduced premiums when compared to a Medicare supplement Plan F while maintaining the “freedom of choice” not offered by a Medicare Advantage plan.
Source: askmedicareblog.com

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