Medicare – Should You Become a Provider?

Posted by:  :  Category: Medicare

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

Video: Medicaid Dental Providers (855) 535-6169

Medicaid kids getting more dental treatment; report has state

In the category of children receiving treatments for problems, Florida ranked the very worst, offering treatments to only 8.3 percent of its more than 1.7 million Medicaid children in 2010. Percentage-wise, however, West Virginia did the best. The state got dental treatments to 49.5 percent of its more than 194,000 Medicaid children.
Source: healthjournalism.org

ADA Offers Free Course on Becoming a Medicaid Provider

Despite misconceptions and fears associated with being a Medicaid provider, treating this population can be rewarding and contribute positively to your bottom line.  Medicaid providers will share three effective practice models and opportunities/challenges regarding compliance, fraud, advocacy and more. After this course, you will be able to:
Source: ksdental.org

Health Insurance Information Related To Medicare Dental Benefits

You can in fact look for a number of medicare supplemental insurance leads online when just go with the search performed by people regarding enjoying medical insurance. The best facet that any medicare health insurance agent can do is try to look for some of these types of medicare insurance heads and MedicareSupplementPlanFGuide.com results. Even if you go through searching for most of the medical insurance sales leads you can always try sorting obtainable people who perhaps may be of age through sixty five as well as get them to consider medigap plans. Most of these products leads are likely to convert into medicare supplement leads as most people’s simply are unaware of it. Trying to find for a premium is merely portion of the way. It’s in addition significant in order to find an organization with the benefit of will seem present for the public. Obtaining their agent at your side that was well-informed to Medicare insurance is the element. They can find up with everyone to be to no doubt you in spite related to everything obtained the most important finest policy created for your will need and finances. Staying on peak of what is very much going on through Medicare and the government is the perfect chief priority pointing to Medigap Select related to Texas for where it reason you just by no means attain to be concerned that you are perhaps not taken good. Performing per annual review because of you as definitely ensures that you are holding your greatest product for your budget. Medicare also has make certain deductible on organizations from doctors and other non-hospital providers, remember, though , that Part Y simply deductible is simply just 5 per 12 at this enough time. After you’ve met that deductible, Medicare cover may be bills? It pays for 80 percentage points of a pre-determined amount. No matter what your doctor charges, Medicare sets the limit for corporations. Incredibly and foremost, you must decide regardless of whether you can justify the more comprehensive doctor/hospital coverage that can comes with a Medicare Supplement routine. These options are more high price than Medicare Positive aspects plans, some at which have incredibly low premiums. However, if your corporation have any sustained or potential fitness problems, the Sc Medicare Supplement could very well save you much, much more money than it is priced at you over the course of the particular year. This is important to you due to the fact means that you can’t be denied coverage, have pre-existing terms excluded or have to pay a steeper premium due to your current or further than health conditions, providing that you are 1 of these periods. A lot seniors that are just becoming recipients of Original Medicare do not realize the social bookmark creating supplemental medicare plans needed for 2012. For those in perfect health, you never know the need during extensive surgery, as well as the need for visiting the emergency room plus some science laboratory work might add in tons related to debt. As can be predicted, for those with an exiting medical problem just as arthritis, cancer, diabetes, or high familiy line levels, not using a medicare supplement project will end ” up ” costing your a lot more then any insurance premium that you possess paid. Far more mistake to escape from is thinking your neighbor’s Texas Medicare insurance insurance will bestow you the coverage you need. One of their more popular supplement options is Plan F. The house covers almost each of the deductibles, coinsurance, and copayments it you end up dealing with within Medicare Parts A good and B. But, if you will have other insurance premiums coverage, you may perhaps well not need each of the the coverage produced by Plan F, for that concern you may actually need Medigap plan at all. Many retirees attain some insurance for their former executive managers or through a retirement plan. Those plans may perhaps possibly cover some of the out of pocket expenses not considered covered by Medicare insurance. That means you can get at a distance with another compliment policy. Yes, I know, real confusing. You’ll find it’s enough for your business to have if you want to get your take effect together to tackle a move of one state on another. The list of tips to do is endless and regularly the last thing that gets dealt out with is those things to do utilizing your health be concerned insurance. The actions you have throughout the one state may not fit what you need in your new abode. The right time for premium payments may change, etc., and the list goes on.
Source: typepad.com

Improving oral health for children in Medicaid, NC Health Choice

Tooth decay is the most common chronic disease among children ages 5 to 19, affecting approximately 1 in 5 children. In North Carolina, 14 percent of children in kindergarten (ages 5-6) have untreated dental decay in at least one primary tooth. A number of factors put some children at greater risk of developing dental cavities, particularly low socioeconomic status and minority race/ethnicity. With proper dental care and dietary choices, dental cavities and decay could almost be eliminated among children. While North Carolina has made tremendous improvements in dental service utilization by children enrolled in Medicaid and NC Health Choice over the past decade, there is still room for improvement. Only 45 percent of children enrolled in Medicaid and 49 percent of the children enrolled in NC Health Choice received at least one preventive service from a dentist in FFY 2012.
Source: ncchild.org

Many Kids on Medicaid Don’t See a Dentist

Even though this number has improved by 16% between 2002 and 2007, there are still many children who cannot access care due to the loss of school-based dental education programs, state budget cuts, low reimbursement rates that prevent providers from accepting Medicaid patients, and the overall lack of Medicaid dollars going toward dental care. Although the Centers for Medicare and Medicaid Services (CMS) has put goals in place for preventive services, the only long-lasting solution will be an increased investment in dental care.
Source: pilcop.org

Tricare charging more for Medicare

Tricare For Life consists of Medicare as first payer and Tricare Standard as second payer. VA facilities are not allowed to bill Medicare, so Tricare has been acting as primary payer, reimbursing VA up to 80 percent of the allowable charge for care. It should have been paying no more than 20 percent.
Source: armytimes.com

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

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

Dental insurance and Medicare – the Medicare Dental & Vision Benefits

Medicare is health insurance plan in US for the seniors as well as disabled people. It gives the basic medical policy, and really helps the seniors & disabled pay for the health care. However, original Medicare doesn’t pay out for everything, as well as dental and vision benefits are limited. The routine care, such as checkups, fillings or glasses, aren’t generally covered in dental insurance and Medicare. The services are covered in case, they are linked with the medical issue such as illness and injury. For instance, dental insurance and Medicare might pay for the hospital stay in case of the complicated dental method. However, it might not at all cover actual dental work. For other example, the Medicare doesn’t generally cover the eyeglasses and contacts. But, it can pay after cataract surgery.
Source: cryonicssocietyofcanada.org

Proposed legislation would expand dental care and services to Medicare and Medicaid beneficiaries and providers

The bill, which has been hailed by seniors groups such as National Committee to Preserve Social Security and Medicare, would pay for the expanded services by levying a tax on non-consumer financial trading. That tax would raise $288 billion over the next 10 years, according to the bill. Click here to read the Senate bill, and here to read Senate report on the U.S. dental crisis. 
Source: mcknights.com

First dentists in the state get THOUSANDS from Medicaid for using TeamLINKS EHR System

Until Monday, only medical professionals and hospitals had met the necessary requirements for the second year of Meaningful Use in the State of Arkansas.   Executives for U.S. HealthRecord cite the use of the TeamLINKS ® system, which is designed specifically for dentists, and the support of Excellence in Healthcare, a firm of industry experts that provide guidance and training to healthcare professionals attempting to achieve Meaningful Use, for the success.
Source: teamlinks.com

Medigap vs. Medicare Advantage

Posted by:  :  Category: Medicare

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The future of Medicare plans, in general, is something that has caused much anxiety for people who are over 65 or will be on Medicare soon. While there has been much debated in the last several years regarding Medicare and Medicare supplement plans, the majority of aspects of Medicare/supplement plans have not changed. Medigap really has not been touched at all, other than a 2010 restructuring of the standardized plans. Medicare Advantage, on the other hand, was involved in the PPACA, cuts to the Medicare Advantage program helped fund health care reform. As of now, though, both program still exist and are going strong. With 11,000 Medicare-eligibles aging in to Medicare every day, there is a constant influx of new people onto these plans.
Source: medicare-supplement.us

Video: Texas Medicare Supplements 2010 How to Choose a Plan

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

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

What are Medicare Supplements?

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Source: medicarechoicesofarizona.com

Will Obamacare Affect Medigap?

Concerning Medigap, a provision of the ACA required the NAIC to review the most popular Medigap plans (C and F) and determine whether or not employing “nominal cost-sharing” would deter enrollees from misusing physician services. The implication was that, because these Medigap plans fill in the gaps of Medicare (thereby covering 100% of Medicare fees) people are over utilizing doctor visits since it comes at no cost to them, and that employing more cost-sharing would help cut federal health care spending.
Source: medicaresupplement.com

What Happened To Medicare Supplement Plans In June 2010?

What Happened To Medicare Supplement Plans In June 2010? After a long hard battle, Congress made changes to the Medicare Supplement rules. The changes to Medical Supplement Plans in June 2010 started on the 1st of the month. The Original Medicare has gaps in the services. It can lead to financial disaster with the coinsurance payments, deductibles, and out of pocket expenses. The new changes give you several choices regarding health care coverage to fill in the gaps between the Original Medicare and the balance of what you are left owing.
Source: seniorcorps.org

Medicare Supplement Plans M and N for June 1, 2010 « Heath Insurance News

  The New Medicare supplement plan N will have benefits similar to Supplement plan D but will have copay benefits similar to those of a Medicare Advantage plans.  Plan N will be a $20 or $25 dollar copay for doctor visits but that will not apply until the $135.00 deductible is paid.  Plan M will have also have benefits similar to supplement plan D but will only cover 50% of the part A deductible and you will still pay the part D deductible. After deductibles are met, there will not be a copay of any type.  It is suspected that plan N will have premiums about 70% lower than the current Plan D (depends on the carrier). Plan M will cost about 90% less than plan D and will more or less take the place of high deductible plan J but with a lower deductible for hospital and physician services vs. the current high deductible J which carriers a $2,000 deductible.
Source: croweandassociates.com

Medicare Supplement Coverage

On June 1, 2010, the new Modernized Medicare Supplement Plans will begin to be sold.  Since Medicare supplement plans were standardized in 1992 there has not been a great deal of change to the plans.  Plans K and L were added but do not seem to have made a significant difference in the market.  Many believe Plans M and N which will be added as a Part of the Modernized Medicare Supplement Plans will make a difference. Particularly, Medicare Supplement Plan N. Let’s look at the highlights of the two plans.
Source: medicaresupplementcenter.com

Treatment Supplement Insurance Solutions Comparison

Any kind of a few but worthwhile differences are during the types behind It worked in Japan why not here? Medigap Plan F in America policies. Coverages K so L have the most differences connected with all the services that are readily obtainable. These the are based to do with percentage rates design between 50 and 75 percent. Plan L featuring less coverage whilst plans A via J. Thought-about the best choice, Plan J boasts better coverage regarding co-payments on guidelines A and F for those found in need of even bigger Medigap Coverage. From year for year Plans Nited kingdom and L can also be limited as a result of out-of pocket expenses which can help ensure those forty somethings and beyond are not take care of more for that many particular plans videos.
Source: huffpozer.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

Source: kaiserhealthnews.org

Video: Medicare Quotes

Daily Kos: Study debunks myth of doctors fleeing Medicare

The two specialties with the highest opt out percentages were psychiatrists (with 1.11% opting out) and plastic and reconstructive surgeons (with 1.56% opting out). In contrast, about a third of one percent of primary care physicians (0.35%) opted out of Medicare. This is not to say there are not serious issues with the compensation system for Medicare providers. On one hand, the current “sustainable growth rate” formula for physician payments has required the annual “doc fix” for years in order to avoid substantial cuts to reimbursements. On the other hand, as the Washington Post and Washington Monthly recently documented in painful detail, the American Medical Association’s rate-setting through its Specialty Society Relative Value Scale Update Committee (RUC) often substantially exaggerates the “values to thousands of services doctors provide.”
Source: dailykos.com

Medicare Advantage coverage to end soon

The 2008 Medicare Improvements for Patients and Providers Act goes into full effect next year. It sets a private fee for companies who had to pay for a network of physicians. However, Humana, Sterling Life, Pyramid Life and United Health Care decided to opt out on the expenses.
Source: seeleymedical.com

Union Bankers Health Insurance Company Review

, provides users with detailed information about Universal’s many Medicare contract program options. Each distinct plan has its own website, tools, information, and forms. Available plans and options vary from state to state so it is important to enter a current zip code so you will see the plan details and options for your city and state.
Source: healthinsuranceproviders.com

Has Anyone Heard of Pyramid Life Insurance Co.

Medicare Supplement and Medicare Select Insurance to cover expenses not paid by Medicare. Medicare Advantage plans designed to provide more benefits than traditional Medicare, including preventive care. Medicare Prescription Drug Plans presenting the opportunity to reduce drug expenses by covering generic and brand name medications. Senior Dental Insurance provides dental savings. Life Insurance to protect the financial legacies of seniors. Cancer Insurance – a specified disease policy limited to cancer coverage – meets the specific financial needs of those battling the disease. Long Term Care Insurance consisting of policies which may cover all levels of nursing home care and home health care. Hospital Indemnity Insurance designed to help cover the rising cost of hospital confinement.
Source: insurance-forums.net

Thursday, August 8, 2013: Bipartisanship, Medicare and wind power — Opinion — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Amerigroup Medicare Tai Chi

Posted by:  :  Category: Medicare

Source: midwoodmartialarts.com

Video: Amerigroup Health Insurance Chiropractor Brandon FL 33511

OneHealth™ Signs Services Agreement with Amerigroup Corporation

Amerigroup, a Fortune 500 Company, coordinates services for individuals in publicly funded health care programs. Currently serving approximately 2.7 million members in 12 states nationwide, Amerigroup expects to expand operations to its 13th state, Kansas, as a result of previously awarded state contract. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers. Amerigroup accepts all eligible people regardless of age, sex, race or disability.
Source: onehealth.com

How Cherry Picking Could Hurt Obama’s Health Care Plan

Health plans started playing games with Medicare in the early 1990s–when the program started its experiments with privatization, paying a fixed amount to private health insurers for each member they could sign up. HMO companies would hold seminars for prospective new members on the third floor of elevatorless buildings or in places that required a long drive. You could count on only the fittest and most self-sufficient seniors to show up. Others would recruit at a 5k charity run or offer gym memberships as a perk and pat themselves on the back for promoting fitness. Barbells are not of much interest to those who are demented, bedridden or in a wheelchair–all health care gobblers, notes Paul Precht of the Medicare Rights Center.
Source: ihuoluoyou.com

Medicare Risk Adjustment Analyst at Amerigroup

is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives. Responsibilities:
Source: jobistan.co

WellPoint reorganization will help integrate Amerigroup, expand in Medicaid market

Deanna Pogorelc is a Cleveland-based reporter who writes obsessively about life science startups across the country, looking to technology transfer offices, startup incubators and investment funds to see what’s next in healthcare. She has a bachelor’s degree in journalism from Ball State University and previously covered business and education for a northeast Indiana newspaper. More posts by Author
Source: medcitynews.com

Stockholders approve $5B sale of Amerigroup to WellPoint

“The acquisition of Amerigroup expands our scale and further diversifies our business mix by deepening our investment in the high growth Medicaid marketplace,” said Wayne S. DeVeydt, executive vice president and chief financial officer of Indiana-based WellPoint, when the acquisition was announced in July.
Source: medicarebyphone.com

WellPoint, Inc. (WLP): WellPoint Bets On Medicare And Medicaid [Centene Corp]

WellPoint should be able to leverage (CUT) some SG&A expenses and benefit from increased negotiating power with hospitals. The firm has already announced that it expects the Amerigroup acquisition to be accretive to earnings in 2013 (assuming the deal closes in the first quarter) and to add at least $1 per share in earnings in 2014. Though the transaction faces regulatory approval, the current administration will likely be in favor of anything that could lower healthcare costs.
Source: seekingalpha.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Amerigroup Health Plan Nj

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Source: insurance-quotez.com

Picking a Medicare D is Nearly Impossible; You Must Do Your Homework

Posted by:  :  Category: Medicare

Source: ajc.com

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

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

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

Medicare 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

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

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

Left Attacks Ryan's Medicare Plan With Falsehoods

“One of President Obama’s regular attacks on Paul Ryan’s Medicare reform is that it would force seniors to pay $6,400 a year more for health care. … The claim is based on a now out-of-date Congressional Budget Office estimate of the gap between the cost of health care a decade from now, in 2022, and the size of the House budget’s premium-support subsidy for a typical 65-year-old in 2022. In other words, the $6,400 has no relevance for any senior today. None. But it also is unlikely to have any relevance for any senior ever because CBO concedes that its number is highly uncertain and ‘will depend on the evolution of the health care and health insurance systems over time, which is hard to predict.’ That’s for sure. The more fundamental problem is that the CBO analysis has nothing to do with the current Mitt Romney-Paul Ryan plan. Nada. Over the last year Mr. Ryan has made major adjustments to his original proposal as he sought a compromise with Democrats. … So how would Ryan 2.0 work in practice? Traditional Medicare and all private insurers in a region would make bids to cover seniors and compete for their business by offering the best value and prices. Then the government would give everyone a subsidy equal to the second-lowest bid. If seniors chose that No. 2 option, whether it was Medicare or another plan, they’d break even and pay nothing extra out of pocket. If they picked the cheapest plan, they’d keep whatever was left over after the government subsidy – that is, they’d get a cash refund. If they instead picked the third-cheapest option, the fourth-cheapest, etc., they’d pay the difference above the government subsidy. That structure ensures that seniors would have at least two choices (and likely far more) that they are guaranteed to do better than they do now. The amount of the premium-support subsidy would also be tied to underlying health-care costs, so it would not shift costs to beneficiaries, as Democrats also falsely claim. The very reasonable Romney-Ryan policy bet is that costs could nonetheless fall over time because seniors would have the incentive to switch to the most competitively priced Medicare plan. … None of these facts are likely to deter Democrats from their distorted claims. But the truth is that the Ryan-Romney reform isn’t anywhere close to Mr. Obama’s cartoon version.” –The Wall Street Journal
Source: patriotpost.us

Caution: Stay away from Medicare Part D plans that have received sanctions from CMS

If you are enrolled in a plan that has been sanctioned, and you have personally been affected by your plan’s poor performance, you may be able to get out and switch plans outside of the Open Enrollment period. Your chance to switch is determined by CMS on a case-by-case basis, so you’ll need to call Medicare at 1 800 MEDICARE (1 800 633-4227), 24 hours a day, 7 days a week. TTY: 1 877 486-2048. Or go to this page at Medicare.gov for more information.
Source: themeddiva.com

Medicare Parts A, B, C, D

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

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

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

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

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

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

The Generation Above Me: Part D Open Enrollment

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

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

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

Providers and Medicare Advantage plans: Improve Efficiency with DxCG Intelligence

Using Verisk Health’s DxCG Intelligence, this Advantage Plan created an Efficiency Index that calculated each provider’s efficiency via a ratio of actual costs to expected cost. The program then compared ratios among all providers in their network. 80% met the plans efficiency goals. With this information, the Medicare Advantage program could target the less efficient 20% and help them control patient costs. As a result, this Plan’s average efficiency has improved over three consecutive years.
Source: 3blmedia.com

Feds ban some Medicare providers in crackdown

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

FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries

A. Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted.  This care requires a doctor’s order and is considered an outpatient service, even though patients may stay as long as several days. The hospitalization can include short-term treatment and tests to help doctors decide whether the patient should be admitted. Medicare guidance recommends that this decision should be made within 24 to 48 hours, but observation visits exceeding 24 hours nearly doubled to 744,748 between 2006 and 2011, federal records show.    
Source: kaiserhealthnews.org

Medicare provider charge data released

The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.
Source: flowingdata.com

Ordering and Referring Providers: CMS Just Won’t Take No for an Answer. Form 855

As of May 1, 2013, physicians and other providers (collectively “Providers”) who bill Medicare must list the NPI of the ordering/referring Provider on their claim forms in order to be paid for the technical component of imaging services, the technical component of clinical laboratory services, durable medical equipment and/or home health services.  An issue arises when the referring/ordering Provider does not participate with Medicare, and does not have an active NPI.
Source: wordpress.com

Daily Kos: Study debunks myth of doctors fleeing Medicare

The two specialties with the highest opt out percentages were psychiatrists (with 1.11% opting out) and plastic and reconstructive surgeons (with 1.56% opting out). In contrast, about a third of one percent of primary care physicians (0.35%) opted out of Medicare. This is not to say there are not serious issues with the compensation system for Medicare providers. On one hand, the current “sustainable growth rate” formula for physician payments has required the annual “doc fix” for years in order to avoid substantial cuts to reimbursements. On the other hand, as the Washington Post and Washington Monthly recently documented in painful detail, the American Medical Association’s rate-setting through its Specialty Society Relative Value Scale Update Committee (RUC) often substantially exaggerates the “values to thousands of services doctors provide.”
Source: dailykos.com

Pro Bono: How Providers Can Help Reduce the Impact of Medicare Payment Cuts

“Paint a Clear Picture.” Your PCR documentation must be accurate, complete and honest, and it should paint a clear picture of the patient’s condition. It should allow the reader to visualize the patient just as you saw the patient on the scene. Medicare’s standard for medical necessity for an ambulance comes down to this: Medicare will only pay for ambulance service when other means of transport are contraindicated. Your PCR documentation must address the issues that relate to this standard. Why does the patient need to go by ambulance now? When reading the documentation, is it clear why the patient cannot be safely transported by wheelchair van, car or taxi? In what position was the patient found, and how was the patient moved to the stretcher? What is the patient complaining of now, and what does the physical assessment reveal? What treatment was provided, and what was the response to this treatment? These are just a few of the questions that relate to “medical necessity” that your PCR documentation should address. Clearly, not all ambulance transports will meet the Medicare medical necessity rules, but your documentation must be complete, accurate and honest so that those who must decide whether the claim is billable will have all the objective information they need to make that decision.
Source: jems.com

IOM says Rochester has lowest Medicare spending rate in nation

Posted by:  :  Category: Medicare

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For example, if an orthopedic practice wanted to buy its own MRI machine and the hospital two blocks away had one that could accommodate those patients, the committee would recommend against it. Insurers can use its recommendations to set reimbursement policies. Experts say the approach tackles the two biggest drivers of rising medical expenses: new technology and salaries. The idea is that those expensive items have to be paid for somehow and they create a need for health care providers to order up more tests and treatments, the cost of which are ultimately passed on to patients and insurers. “Supply-driven use of services is one of the major drivers of unwarranted, wasteful health care expenses,” said Dr. Martin Lustick, chief corporate medical director for Rochester-based nonprofit insurer Excellus BlueCross BlueShield. State Health Commissioner Dr. Nirav Shah called Rochester’s “a phenomenal model.” “The governor’s plan is to do regional planning across New York using Rochester as the example,” Shah said. “It’s about bringing rationality to the system. It’s about adult supervision and not a Wild West. Right now, supply drives demand.” Institute researchers say U.S. health care cost $2.7 trillion in 2011, almost 18 percent of the gross domestic product and higher than other developed countries. The institute, a nonprofit arm of the National Academy of Sciences, advocates payment reform to push competition toward value rather than toward volume of services, including the Medicare system that covers 39 million people age 65 and older and 8 million with disabilities. “The chaotic free market health care system costs Americans a bundle,” said Blair Horner, legislative director of the New York Public Interest Research Group, adding there would probably be pushback from providers against regional committees limiting their expansion plans. “Rochester offers a way to do it better.”
Source: modernhealthcare.com

Video: New West Medicare REVISED.mov

Medicare to Levy $227M in Fines Against Hospitals

Because Medicare applies the penalties to every payment for a patient stay, hospitals can only estimate what the dollar amount of the fines will turn out to be. Some large hospitals may end up losing more than $1 million from the penalties if last year is any guide. But hospitals that succeed in reducing readmissions may end up with even less revenue by forgoing those second patient admissions, said Erik Johnson, a senior vice president at Avalere Health, a Washington consultant group that advises hospitals and other providers. “The economics of it still do not make a tremendous amount of sense, honestly,” he said. “I think hospitals are being good actors in trying to bring these numbers down.”
Source: thefiscaltimes.com

MIAMI: Exchanges create confusion for Medicare recipients

In this image made available by AARP shows Ida Gall, right speaking to an unidentified customer at the Connecticut Women’s Expo on Saturday, Sept. 7, 2013 in Hartford, CT. AARP Connecticut volunteers Ida Gall and Sophia Forbes, seated, talked to women about the Affordable Care Act. Federal Health Officials are assuring medicare recipients that their benefits will not change when the Affordable Care Act starts. Many are confused by overlapping enrollment periods for Medicare and the Affordable Care Act.
Source: heraldonline.com

Medicare Home Health Compare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

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September 15, 2013

Centralia IL Tax Expert Guides You Through The New World of Medicare Decisions

Posted by:  :  Category: Medicare

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Medicare Ratings System To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: centralia-il-taxservice.com

Video: AFSCME wants Medicare advantage, so IL will ablige

Duckworth Discusses Concerns About Cuts To Social Security, Medicare With Elgin Residents

“We’re sitting here looking at four major surgeries for cancer. We’ve just gotten through the fourth one … and we have tens of thousands of dollars worth of bills that are covered by Medicare,” Ceithaml said after meeting the congresswoman. “We would have lost our house three times over already if there had not been the present level of Medicare, and to make it a lower level is just unconscionable.”
Source: progressillinois.com

Government looks into Medicare fraud by medical device companies

The alleged fraud was first brought to the subcommittee’s attention after receiving a letter from a Missouri doctor who suspected that some medical device companies were trying to receive Medicare compensation by selling expensive equipment to patients who did not request or need the devices. The subcommittee quickly discovered that there were more cases nationwide just like this one.
Source: rabinsslaw.com

Chart of the Day: Public Ignorance About Medicare is Really, Really High

It also turns out that when you ask people why Medicare costs are rising, they rate fraud and poor management at the top and new technology at the bottom. The truth, again, is just the opposite. Medicare has some fraud problems, but they’re fairly modest. It’s basically a pretty well managed program. New drugs and new treatments, however, are responsible for nearly half of the increase in Medicare costs over the past few decades. It’s the #1 cost driver by a ton. Adrianna McIntyre has the details here.
Source: motherjones.com

What Exactly Is Il Medicare?

The Il Medicare program has changed drastically over the last few years. There are many different aspects to the program that most people have no idea even exist. The old Medicare program offered primarily two parts Part A for hospitalization and Part B for doctors visits there were other parts as well but they were not used as frequently as the first two parts. Il Medicare is a totally different animal today. There is Medicare Advantage a government subsidized program through private insurance companies, Medigap coverage also offered through private insurance companies and a slew of Medicare supplement programs. Familiarizing yourself with all the options is important for your own welfare and that of the folks in your life who are 65 years and older.
Source: abchealthplans.com

BlueCross BlueShield of IL Changing Medicare Supplement Rates

BlueCross BlueShield of IL announced a rate increase for most Medicare Supplement/Medigap customers effective March 1, 2013. In addition to the rate increase, changes have been made to the way BlueCross BlueShield of IL sets attained-age premiums. BCBSIL has switched from age bands to different rates for each age. In the past, BCBSIL had the same rate for the same Medigap plan for age groups, like 65-67; now, each age has its own premium rate. The change from age bands to single age rates will cause a few premiums to actually be lower after March 1, 2013 than they are now. For most people though, premiums are increasing.
Source: bcmil.com

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

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

Whistleblowing Docs Allege Vast VUMC Medicare Deception

Under the False Claims Act, the federal government can intervene and prosecute these types of cases after they are filed by whistleblowers. While they decide, the case remains sealed (this suit was filed in early 2011). In this instance, the Department of Justice requested five extensions to the deadline to decide whether to intervene. A judge denied the fifth motion, unsealing the complaint, though the feds say they will continue their investigation and reserve the right to intervene later.
Source: nashvillescene.com

Senior Care in Oswego, IL: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: safeathomehealthcare.com

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September 15, 2013

CMS Announces Marketing Sanctions for Three Medicare Advantage Carriers: Health Net, Arcadian and Universal American

Posted by:  :  Category: Medicare

[…] CMS isssued a press release on Friday afternoon announcing these marketing sanctions.  The sanctions for Health Net took effect at mid-night last Friday, so as I write this, they are currently unable to take an new enrollments.  The sanctions for Arcadian Management and Universal American Corp will not take effect until Sunday, December 5th, so agents will be allowed to enroll new members in these plans for approximately 2 weeks until the sanctions take affect.  For Universal American, the sanctions DO NOT include their stand alone part D plan, only their Medicare Advantage plans.Source: ritterim.com […]
Source: ritterim.com

Video: Health Net Medicare Advantage – Compare to over 180 Compani

Health Net sanction means one less low

The agency said it took action because Health Net has “continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.”
Source: oregonlive.com

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

Health Net Federal Services Awarded New Va Contract

Boisvert for USA TODAY) Story Highlights Kaiser study found tax credits could push cost down to below $100 per month Avalere study found big price differences among age groups On Jan. 1, all Americans will be required to have coverage or face fines SHARE 184 CONNECT 59 TWEET 45 COMMENTEMAILMORE WASHINGTON (AP) Coverage under President Obama’s health care law won’t be cheap, but cost-conscious consumers hunting for lower premiums will have plenty of options, according to two independent private studies. A study released Thursday by the nonprofit Kaiser Family Foundation found that government tax credits would lower the sticker price on a benchmark “silver” policy to a little over $190 a month for single people making about $29,000, regardless of their age. By pairing their tax credit with a stripped-down “bronze” policy, some younger consumers can bring their premiums down to the range of $100 to $140 a month, while older people can drive their monthly cost even lower well below $100 if they are willing to take a chance with higher deductibles and copays. A separate study released Wednesday from Avalere Health, a private data analysis firm, took a wide-angle view, averaging the sticker prices of policies at different coverage levels. Read more: http://www.usatoday.com/story/news/politics/2013/09/05/health-care-law-studies/2769377/
Source: bigcontact.com

HIPAA Warning: Do Not Attempt to Hide A Data Security Breach as Health Net Did

When a portable disk drive went missing from a Connecticut office of insurance company and Medicare Advantage contractor Health Net last May, the law required them to notify authorities and affected customers immediately. Instead they kept it under wraps until November. According to an independent security company report, they also lied about it being a theft, neglected to mention two laptop PCs were also stolen, and falsely reported the data was unreadable without special software. Some officers may be exchanging pin stripes for striped suits. Even if they do not, the story is an excellent case study in how not to handle a data breach involving patient information.
Source: homehealthnews.org

Health Net, Inc. (HNT): Health Net’s CEO Discusses Q2 2011 Results

Turning to Medicare, as of Monday, August 1, 2011, CMS lifted certain marketing and enrollment sanctions against Health Net. We’re now able to sign up new members with September 1 effective dates. In June, we submitted bids for 2012 and we can now look forward to our active participation in the annual enrollment period, starting October 15 for January 1 enrollment. The absence of new members due to these sanctions affected both MA enrollment and MCR. There were some revenue timing items that impacted the MCR in the second quarter. We continue to grow and do well in Medicaid. But the tough economy continues to drive Medicaid enrollment higher for Health Net. In addition, on June 1, we started enrolling new members from the senior and persons with disability population here in California under a new mandatory managed care program. This population historically has been in fee-for-service Medicaid, though we’ve been enrolling some of them on a voluntary basis for some time. For now, we expect to enroll between 6,000 and 8,000 new SPD members monthly through May of 2012. As of June 30, 2011, we have approximately 38,000 SPD members, after adding 8,600 new members in June. As we indicated earlier, our full year guidance assumes higher MCRs for this population than for the overall Medicaid program.
Source: seekingalpha.com

Get Early Protection Against the Flu

There are specific groups who are considered to be at high risk of being hospitalized or dying from flu complications.  The high-risk groups are children six months and older, adults 65 years of age and older, and pregnant women.  Individuals with the following conditions are also at higher risk.  They include people with:
Source: dekalbhealth.net

CVS Caremark looks to purchase Health Net's stand

“We believe this proposed transaction is in the best interests of our Medicare PDP members and our stockholders,” stated Jay Gellert, president and CEO of Health Net. “Our Medicare PDP members, who have received certain services from CVS Caremark for five years, will now be affiliated with one of the nation’s largest Medicare PDP sponsors.
Source: drugstorenews.com

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September 15, 2013

Medicaid kids getting more dental treatment; report has state

Posted by:  :  Category: Medicare

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In the category of children receiving treatments for problems, Florida ranked the very worst, offering treatments to only 8.3 percent of its more than 1.7 million Medicaid children in 2010. Percentage-wise, however, West Virginia did the best. The state got dental treatments to 49.5 percent of its more than 194,000 Medicaid children.
Source: healthjournalism.org

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

Dental hygiene students work at NRV dental clinic

“Having the hygiene students here is a two way blessing; it helps our patients receive care in a timelier manner and it helps the students to refine their professional skills,” said Roz Nelson, director of administration and dental operations. Althea Grubb, clinic staff dental hygienist, assists the students and grades them on their job performance.
Source: southwesttimes.com

WSJ Emphasizes Difference Between Medicare, ACA.

The Wall Street Journal Share to FacebookShare to Twitter (9/7, Waters, Subscription Publication) warned readers covered by Medicare to steer clear of the Affordable Care Act’s marketplaces. Despite having overlapping open enrollment periods, the exchanges and Medicare are different programs. As Richard Olague, spokesman for the Centers for Medicare and Medicaid Services, explained, “We want to reassure Medicare beneficiaries that they are already covered, that their benefits aren’t changing and that the Marketplace doesn’t require them to do anything different. Specifically, they do not have to change their Medicare coverage or enroll in any Marketplace plan.”
Source: bluebridgebenefits.com

For Example: Medicare Doesn’t Cover Dental Care

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

Medicare – Should You Become a Provider?

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

ibm medicare options: IBM Medicare Extend Health Does NOT Negotiate Insurance Premiums

It has been confirmed a couple of times that the Extend Health Medicare insurance products we will be offered are a subset of the SAME products in the general marketplace and will be the SAME price. One would think Extend Health would have more leverage with insurance companies.  Here’s an even bigger irritant.  EH will probably not offer the cheapest Medicare insurance products in your zip code.  They offer insurance products where they are paid a commission from the insurance company to sell those products.  I continue to urge you to decide what kind of products you want to get BEFORE you talk to an Extend Health advisor.  By way of example, I will tell you what I am doing.  I looked on Extend Health’s website to see what was offered to employees of other companies.  I did that by looking at www.extendhealth.com/dupont and www.extendhealth.com/gm  (isn’t it interesting that anyone can go to www.extendhealth.com/ibm which is the site we are using to enter our profile information) and I saw the products offered by EH in my zip code in 2013. I am reasonably sure it will be the same stuff offered to us.  I am specifically interested in a medigap plan called F high deductible (F+).  Unfortunately, the F+ plan offered by Extend Health is not the cheapest plan in my zip code.  That’s really irritating as there is no difference in the content of a medigap plan from one company to another.  By law, all F+ plans must offer the same coverage.  However, I have to use the one offered by EH to get the HRA subsidy.  Here’s my decision on what kind of products I want to buy:
Source: blogspot.com

Medicare Dental question raised again : Bite Magazine

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

ADA Offers Free Course on Becoming a Medicaid Provider

Despite misconceptions and fears associated with being a Medicaid provider, treating this population can be rewarding and contribute positively to your bottom line.  Medicaid providers will share three effective practice models and opportunities/challenges regarding compliance, fraud, advocacy and more. After this course, you will be able to:
Source: ksdental.org

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