Medicare Community Meeting

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This innovative program provides the structure and routine needed to ensure feelings of security and certainty in day-to-day life and include music, exercise, arts and crafts, gardening, resident pets and reminiscing, along with supervised family-life experiences, such as setting the table or folding laundry.
Source: assuredassistedliving.com

Video: Assisted Living Los Angeles Now Medicare Assisted Living

Reinventing Medicare

Choosing a Structured Arrangement to Fund a Medicare Set

Posted by:  :  Category: Medicare

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“If a structured arrangement is utilized to fund a WCMSA, the claimant is required to make an initial deposit in an amount equal to the first surgical procedure or replacement and two years of annual payments. After the initial deposit, the structure is designed to allocate regular deposits over a designated period of time. Once the funds are exhausted in a given period, Medicare will pay primary for further injury-related expenses during that period.”
Source: legalexaminer.com

Video: Medicaid Set Aside

Workers’ Compensation: NJ Court Approves Medicare Set

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

CARR ALLISON Medicare Compliance Group: Workers’ Compensation Medicare Set

The bill would also create a formal appeals process for parties in a workers’ compensation case to challenge CMS determinations. If CMS does not approve the MSA proposal, parties would have 60 days to file a reconsideration request, and CMS would have 30 days to respond or the original MSA proposal would automatically be deemed approved. Parties would have 30 days to request an ALJ hearing after an unfavorable response to a reconsideration request. If the ALJ issues an adverse decision or fails to issue a decision within 90 days, parties would then be able to seek judicial review of the CMS determination.
Source: blogspot.com

Workers’ Compensation Medicare Set

In an effort to address as many topics as possible, CMS is requesting stakeholders to submit non-case specific questions they would like to have addressed during the teleconference to the CMS MSP Central mailbox* prior to the teleconference. CMS will review and categorize the questions submitted and attempt to answer as many questions as possible during the teleconference. There may also be an opportunity for the stakeholders to ask questions after the presentation.
Source: medval.com

Medicare Set Aside Arrangements

Leading source of structured settlement information and news and expert opinion from John Darer, including settlement planning issues/ ideas, alternative deferred payment solutions, The Structured Settlement Watchdog™ commentary and exposes that may be helpful to attorneys, plaintiffs, claims adjusters, judges, the news media, sellers and buyers of structured settlement payment rights and interested others, Informative, irreverent and effective! Check back daily for something new, or simply ask structured settlement expert John Darer™ directly 203-325-8640
Source: typepad.com

Ninth Circuit Vacates Injunctions Barring HHS From Seeking Prepayment of Medicare Secondary Payer Reimbursements

Posted by:  :  Category: Medicare

On appeal, HHS argued that the plaintiffs lacked standing, that the case was moot, and that the district court lacked subject matter jurisdiction.  HHS also argued that, on the merits, HHS’s interpretation of the Medicare secondary payer provisions was reasonable.  The Ninth Circuit held that the lead plaintiff failed to satisfy her presentment and exhaustion requirements when she filed her claim at the administrative level.  Because the claim was not properly presented to the agency, the Ninth Circuit found that the district court lacked subject matter jurisdiction.  On the merits, the Ninth Circuit held that HHS’s construction of the reimbursement provision was rational and consistent with the statute’s text, history, and purpose, and it vacated the injunctions entered by the district court.  The Ninth Circuit remanded the case for consideration of the plaintiffs’ due process claims.
Source: jdsupra.com

Video: Medicare Secondary Laws

Reps. Reichert and Thompson Introduce Bipartisan Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act

The Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act establishes clear and consistent standards for an administrative process that provides reasonable protections for injured workers and Medicare.  It would benefit injured workers, employers and insurers by creating a system of certainty, and allows the settlement process to move forward while eliminating millions of dollars in administrative costs that harm workers, employers and insurers.
Source: house.gov

Workers’ Compensation: CMS Publishes Rules to MSP Payments Under the SMART Act

Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented SMART Act. The Regulations expand the bureaucratic framework for Medicare beneficiaries and their representatives in order to obtain and appeal information on condition payment demands from the government. The Rules are effective on November 10, 2013 and the comment period closes at 5pm on that date. The government will be establishing a multifactorial implementation process to keep information secure: DX Codes, provider names. dates of service and conditional payment amounts. Ultimately, it appears that the process will be yet another hurdle to obtain information for workers’ compensation claims  and release the beneficiary from government liability for medical expenses. The proposed CMS Rules can be reviewed at: https://www.federalregister.gov/articles/2013/09/20/2013-22934/medicare-program-obtaining-final-medicare-secondary-payer-conditional-payment-amounts-via-web-portal
Source: blogspot.com

Why Dialysis Costs So Much, Part 2: Medicare Secondary Payer Regulations

Solutions such as DiaSource negotiate directly with an accredited network of dialysis providers to secure the lowest treatment rates possible. DiaSource works with insured patients to find the most convenient location for them at a price far below average. Typically, DiaSource saves private insurers, self-insured employers and third-party administrators 76 percent per treatment.
Source: diasourcesolution.com

Long Waits For Consumers When Medicare Is ‘Secondary Payer’

In one case involving an 80-year-old man who was injured in a car accident in Kentucky in November 2011, it took more than a year to get a final figure from CMS detailing how much the agency was owed, says Linda Magruder, an attorney in Louisville who was the victim’s co-counsel in the case. That amount, for treatment for soft-tissue injuries to the man’s right hip, left foot, back and neck, was $2,640. But the agency first claimed it was owed more than $26,000, she says, because it included bills for care not related to the accident.
Source: kaiserhealthnews.org

Medicare Secondary Payer Activities Expected to Accelerate This Fall

ABOUT ALLSUP Allsup is a nationwide provider of Social Security disability, veterans disability appeal, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Allsup professionals deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. Founded in 1984, the company is based in Belleville, Ill., near St. Louis. Visit http://www.AllsupInc.com.
Source: virtual-strategy.com

Excellus BCBS holding free Medicare planning meetings for Kodak retirees

Posted by:  :  Category: Medicare

Kodak retirees who will lose their health care benefits by the end of this year can ask questions and get answers from Excellus BlueCross Blue Shield Wednesday. Excellus is offering free Medicare planning seminars. The first one is at 9:30 a.m. at the Wishing Well on Chili Avenue in Chili. Click here for dates of additional seminars.
Source: whec.com

Video: Excellus BCBS Medicare plan travels with you

Local prescription drug plan earns top marks from Medicare

BlueCross BlueShield Rx PDP contracts with the federal government and is a stand-alone prescription drug plan with a Medicare contract. The plan is administered by Excellus BlueCross BlueShield in cooperation with Empire BlueCross, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. It’s available to Medicare eligible members who reside in New York State.
Source: readmedia.com

Excellus BlueCross BlueShield is Accepting New Enrollment in Family Health Plus and HMOBlue Option in Oswego County

• Care by a primary care provider who belongs to HMOBlue Option/Family Health Plus; • Specialist visits referred by your doctor; • Emergency room services; • Laboratory/radiology and other diagnostic tests and treatments; • OB/GYN and maternity care; • Mental health and alcohol/substance abuse services (some limits on visits apply); • Physical, speech and occupational therapy (some limits on visits apply); • Eye exam and eyeglasses; • Hearing services; • Medical supplies and equipment; • Home health services; • Transportation for medical care, depending on the county in which you live; • HIV testing, pre- and post-test counseling as part of a family planning visit; • Family planning and reproductive health services; • Prescription drugs (copays and some limits may apply); • Dental coverage (Family Health Plus only).
Source: oswegocountytoday.com

Open Enrollment and Star Ratings for 2013

MA plans and PDPs have a number of concerns about the methodology used to establish the star ratings, including the age of the data (e.g. the 2013 ratings are based on 2011 data), the frequent changes in methodogy and the difficulty in improving scores from year to year. For most plans these ratings are good news and the star rating has gone up for most measures from 2012 to 2013. Three new measures focused on care coordination and improvement. For MA-PDs, the national average for the care coordination measure was 85 percent or 3.4 stars. Non-SNPs performed better on this measure than SNPs. The measure for net improvement showed that MA contracts on average achieved a score of 3.1 for Part C and 3.4 for Part D while PDPs achieved an average score of 4.1. However approximately 10 percent of the plans will see a lower bonus as a result of their new lower ratings and plans with 2.5 stars or less for three years in a row face the possibility of termination from the program.
Source: gormanhealthgroup.com

Excellus Bluecross Blueshield rebates $3.1 million to New Yorkers

“My office will continue to look out for New Yorkers who face improperly denied health insurance claims and ensure that they are repaid the money they are owed. We are pleased that Excellus Bluecross Blueshield has refunded money to thousands of New Yorkers,” stated Attorney General Eric T. Schneiderman.
Source: lifehealthpro.com

Broome County Health Department Announces Seasonal Flu Clinics for Fall 2009

The fee for the flu vaccination is $20. The pneumonia shot is also available for Medicare Part B recipients aged 65 and older at Broome County Health Department sponsored clinics (*) only. There will be no out of pocket fee for the flu or pneumonia shots for Medicare Part B recipients. Individuals on Medicare must present all insurance cards to staff at the clinic. If you have signed up with Today’s Options-American Progressive or Excellus Medicare Blue PPO Medicare Advantage Plan, we can charge your plan. For other Medicare Advantage Plans, such as Aetna Golden Medicare, CDPHP Medicare Choice, etc, you need to go to your primary care provider for the flu shot or be prepared to pay by cash or check.
Source: gobroomecounty.com

Changes in Medicare Supplement Plans Coming in 2010

Posted by:  :  Category: Medicare

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Seniors are advised to review their Medicare plans to see if they will be effected by the changes or if they can get lower rates with the new plans. They may also wish to consider obtaining Medicare Part D to cover some costs of medications. Medicare Part D helps to reduce the cost of many medications, but may not be used in conjunction with some Medicare Plans. Therefore, it is recommended that all Medicare subscribers review their options with an advisor that can provide specific information and advice on a case-by-case basis to Medicare subscribers.
Source: theoneplacetoshop.com

Video: Driver License Renewal Increase and Medicare Social Security changes for 2010 2011

THE 2010 NEW MODERNIZED MEDICARE SUPPLEMENT PLANS ARE FINALLY HERE

The changes to medicare/medigap plans have arrived and are now approved in most states. There are some very exciting changes. Several plans have been eliminated such as E, H, I, and J. Plan M and Plan N have been added. Plan N has been getting a lot of attention. It has some features that make it very affordable. It allows you to go to any doctor or hospital that accepts medicare without any need for referrals. The main feature not seen before in medigap plans or Medicare supplement plans is the addition of copays. You will pay up up $20 for an office visit, and $50 if you receive treatment in an emergency room. It will be waived if you are admitted to the hospital. The insured is also responsible for paying the part B deductible for the year of $155. The rates are coming in at 25-30% less then the popular plan F. With this type of savings we feel plan N will end up being one of the two most popular plans along with plan F. For more information about medicare supplement plans, medigap plans, medicare supplement, medigap quotes, or medicare advantage plans, please visit our website at Medigap4Seniors, or call us at 1-888-502-5553.
Source: swdemo4u.com

Five Questions About President Obama’s Proposed Changes To The Medicare Payroll Tax

Right now, that couple would pay $3,987.50 in Medicare taxes each year. Under the proposal, they would pay $4,212 on their wages and $4,350 on their investment income, $8,562, assuming all of that income is taxable. Congressional estimators predict any final policy would include some exemptions, such as the costs of generating investment income. 3. Who would be affected? Taken together, both the earned- and investment-income portions of the tax would hit the top 2.6 percent of U.S. households, according to The Tax Policy Center, a joint project of the Urban Institute and the Brookings Institution. That would allow Obama to keep his campaign promise not to raise taxes for 95 percent of the country’s households. The tax on investment income would not apply to some non-wage income from certain small businesses. Under current law, employees of S corporations, a type of company with a limited number of shareholders, are able to receive some of their income as distributions – a share of the companies’ profits – rather than as wages. Lobbying by business groups helped ensure that S corporations’ employees who are also shareholders wouldn’t face the new tax on their share of the profits. However, people who invest in S corporations, but do not participate in the operation of the business, would have to pay the new Medicare tax on any dividends or other unearned income they receive from the business. 4. How does the Obama plan compare to Democratic congressional proposals? Democratic leaders working toward a compromise between the House and Senate bills had tentatively reached a labor-backed compromise that included a Medicare tax on investment income less than a week before Republican Sen. Scott Brown’s Jan. 19 election in Massachusetts undercut Democrats’ filibuster-proof majority and stalled the debate. The investment-income tax was suggested last year by Sen. Debbie Stabenow, D-Mich., but senators rejected the plan. The Senate also refused to accept a House plan to increase taxes on the rich. However, the new taxes proposed by Obama have not provoked any serious complaints from Senate Democrats yet. The tax will likely have some appeal to the more liberal House members, who resisted the Senate’s Cadillac tax. Unions, an important constituency for liberal House lawmakers, have argued that the Cadillac tax would affect some middle-class union members with high-value health benefits. Obama’s proposal would subject fewer plans to that tax.
Source: kaiserhealthnews.org

Medicare Cuts, Obamacare Prompt Hospital Layoffs

“The sheer magnitude of the Medicare and Medicaid cuts impel us to look at all of our services and costs, including the largest component of our budget—personnel,” Cummings said, citing a 20 percent cut in Medicaid proposed by Democratic Gov. Dannel Malloy and approved by the state legislature resulting in a $550 million hit to Connecticut hospitals. Sequestration also resulted in an additional $1 million loss for L + M this year.
Source: freebeacon.com

The perils of the 2010 Medicare physician fee schedule : Getting Paid

As we resume our story, we find that the fee schedule was, indeed, rescued (at least temporarily) by Congressional and Presidential action.  Specifically, in late December, Congress passed, and the President signed, the Department of Defense Appropriations Act of 2010, which provides for a zero percent update to the 2010 Medicare physician fee schedule for a two month period, Jan. 1, 2010 through Feb. 28, 2010.  That essentially means that the Medicare conversion factor (i.e., the dollar multiplier that translates relative value units, or RVUs, into payment amounts under the Medicare physician fee schedule) will stay at the 2009 level through the first two months of 2010.  Physicians may still see some changes in Medicare payment allowances from 2009 levels due to changes in RVUs, but for many of the services most commonly provided by family physicians, those RVU changes are positive. 
Source: aafp.org

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September 23, 2013

Selling Marketplace Plans To Medicare Beneficiaries Will Be Illegal

Posted by:  :  Category: Medicare

With so much publicity surrounding the opening next month of the new Internet-based marketplaces, seniors could easily think the health law’s marketplaces, also called exchanges, offer options for them too. Federal officials have been eager to steer them away, in messages on both the exchange and Medicare sites and in a special notice that will appear in the 2014 Medicare & You handbook mailed this month to 52 million beneficiaries.
Source: kaiserhealthnews.org

Video: Medicare Advantage – 5 Things To Know About Advantage Plans Before You Enroll

Medicare Drug Plan Polls Suggest Bright Future for Obamacare

Looking back on it, the public’s turnaround from initial rejection to growing support for Part D was understandable. The unfunded $400 billion program that President Bush signed into law in December 2003 was needlessly complex for seniors and unnecessarily expensive for taxpayers. Rather than having the government negotiate prices directly with pharmaceutical firms and add drug coverage into the traditional Medicare program, President Bush and his Republican allies in Congress instead gave recipients subsidies to purchase plans from private insurers. Making matters worse, millions of “dual eligible” already receiving drug coverage from Medicaid had to switch to the new scheme, a process that left millions unable to pay for their prescriptions for weeks in early 2006.
Source: crooksandliars.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

How the ObamaCare Healthcare Exchanges Affect Seniors on Medicare

Medicare retirees can still have a drug-only plan, or one of the Medicare Advantage plans run by private insurers. You do not have to select plans through the new exchanges. This is the same for Medicare Part A (hospital coverage), Part B (doctor visits), Part C (Advantage plans) and Part D (prescription drug plans). Medicare recipients are not even able to apply for any Medicare health coverage, including Medigap plans, on the exchanges. You can, however, still revise your current Medicare plan or pick a different one as you have before, using the Medicare Benefits Plan Finder.
Source: medicarebenefits.com

Later generations pay more for Medicare, Social Security

The CBO projected that each successive generation—depending on when they were born—will pay more in lifetime payroll taxes and receive more in lifetime Medicare benefits. Over their lifetime, beneficiaries born in the 1940s would, on average, receive about $160,000 in benefits, net of premiums paid, and pay about $45,000 in payroll taxes. Those born in the 1950s would receive about $205,000 in benefits and pay $60,000 in payroll taxes. Those born in the 1960s would receive an average of $270,000 in benefits and pay about $65,000 in payroll taxes.
Source: benefitspro.com

Alternative Recommendations from Long Term Care Commission Members, Including the Center’s Judith Stein 

We issue this statement to express our shared vision of what is necessary to meet Congress’s mandate to establish and finance a high-quality, comprehensive LTSS system for Americans who need such services. The authors’ vision is to create an inclusive LTSS system for people of all ages – a system that will meet individuals’ functional and cognitive support needs with quality care in the least restrictive setting. We are convinced that no real improvements to the current insufficient, disjointed array of LTSS and financing can be expected without committing significant resources, instituting federal requirements, and developing social insurance financing. 
Source: medicareadvocacy.org

Geriatrician: Eliminate Medicare’s 3

Around the same time, he wrote, the Health Care Financing Administration, now the Centers for Medicare & Medicaid Services, analyzed test projects in Oregon and Massachusetts that eliminated the rule and found an estimated annual net Medicare savings of more than $180,000 in Oregon and more than $120,000 in Massachusetts. The HCFA elected to keep the rule in place, as these savings applied to the entire Medicare population were not particularly large and the lack of the rule did not discernibly affect quality of care.
Source: fiercehealthcare.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

Most Senior Citizens Are Satisfied with Medicare Part D for Prescription Drug Coverage

How well has it worked? A recent survey of retirees concludes that this program has been highly successful. Nine out of 10 people covered by Part D are satisfied with their drug coverage. The program enables seniors to save money and have access to medicine they might otherwise skip. 
Source: peoplespharmacy.com

Daily Kos: Company that improperly billed Medicare for scooters forced out of business

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Source: dailykos.com

Medicare Open Enrollment Period Begins Oct. 15, 2013

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

Medicare Patients at Jeopardy

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Source: massdevice.com

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September 23, 2013

Medicare Home Health Compare

Posted by:  :  Category: Medicare

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

Video: Health Insurance Improving Medicare In 2011 Closing The Donut Hole

Census: More Americans Have Health Insurance As People Age Into Medicare

One provision — which took effect Sept. 23, 2010 — allowed parents to keep their children as dependents on their health insurance policy until age 26. Much of the benefit was realized in comparing 2011 uninsured rates with 2010 rates for people 19 to 25 years old, but there was some continued help last year, Day said. The number of uninsured Americans 19 to 25 years old decreased from 8.27 million in 2011 to 8.21 million last year, a drop of 66,000, or one-half of a percent of the 30 million in that age category. Connecticut passed this provision in 2009, earlier than the federal law.
Source: courantblogs.com

Committee Seeks Update from CMS Administrator on Implementation of Efforts to Protect Medicare Funds

In the letter to Administrator Tavenner, the leaders wrote, “While it is our understanding that CMS has made some progress in implementing the SMART Act and improvements to the MSP program, some challenges remain. In August 2011, CMS announced that it would only pursue those claims with a recovery value of $300 or more in certain liability insurance cases. However, it is our understanding that CMS continues to pursue claims below the $300 threshold. In addition, CMS has not promulgated certain regulations and rules required under the SMART Act by the deadlines specified in the law.”
Source: house.gov

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

The Facts about the Government’s Medicare Cost Projections

This chart compares Congressional Budget Office long-term projections of the debt held by the public from 2010 with long-term projections calculated in 2007. In 2007, the CBO projected that the debt held by the public would surpass 60 percent in 2023. Note that this long-term projection incorporated policy changes that were deemed likely at the time. Using the same methodology last year, the CBO projected that the debt will exceed 60 percent of GDP by the end of 2010. In the three years between projections, the debt milestone has accelerated by 13 years. This unforeseen acceleration is worth careful consideration; as the government consumes more credit, less will be available to the private sector.
Source: reason.com

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September 23, 2013

Upcoming CMS Jurisdiction 6 Medicare Contractor Change

Posted by:  :  Category: Medicare

The Centers for Medicare and Medicaid Services (CMS) has awarded the Medicare Administrative Contractor (MAC) Jurisdiction 6 contract to National Government Services (NGS). Testing has been completed with NGS. CPID: 1437 Payer Name: Illinois Medicare Transition Date: 9/7/2013 Current MAC: Wisconsin Physicians Services (WPS) Old Payer ID: 00952 New Payer ID: 06102 CPID: 1434 Payer Name: Wisconsin Medicare Transition Date: 9/7/2013 Current MAC: Wisconsin Physicians Services (WPS) Old Payer ID: 00951 New Payer ID: 06302 CPID: 1435 Payer Name: Minnesota Medicare Transition Date: 9/7/2013 Current MAC: Wisconsin Physicians Services (WPS) Old Payer ID: 00954 New Payer ID: 06202 Providers must be aware of the following: • NGS will accept claim files with the current Contractor Number (Payer ID) until 4:00 PM CT on Friday, 9/6/2013 . To allow NGS to make the necessary system modifications for the new Contractor Number (Payer ID), the NGS Gateway will not be available on 9/6/2013 from 4:00 PM CT until 8:00 PM CT. • The clearinghouse will hold claims that are sent after 3:00 PM CT on Friday, 9/6/2013. • The clearinghouse will send files with the new Contractor Number (Payer ID) to NGS on Monday, 9/9/2013. • The final WPS legacy Electronic Remittance Advice (ERA) files will have a paid date of 9/6/2013 and will be available on Monday, 9/9/2013. All subsequent ERA files will show the J6 contractor number as the Medicare payer identifier. Contractor number (Payer ID) changes: • Providers do not need to change Contractor Number in the claim. The clearinghouse will manage the Contractor Number changes for our customers. NGS has established a Medicare A/B Jurisdiction 6 Implementation website http://www.ngsmedicare.com that contains Jurisdiction 6 transition information. Action Required: Please be aware that the clearinghouse will manage the Contractor Number change, no action is required by the provider to make this change. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Video: Medicare song

Important Information Regarding Medicare Claims and Payments for Part A Indiana and Michigan Providers

National Government Services, Inc. (NGS) recently announced important information regarding Medicare claims and payments for Part A Indiana and Michigan providers.  With the impending transition of these providers to Wisconsin Physician Services (WPS), NGS posted the following transition timeline:
Source: hallrender.com

NATIONAL GOVERNMENT SERVICE (NGS)

 All Part B providers located in Illinois, Minnesota and Wisconsin will be transitioning to NGS.    All related education and communication will flow from the National Government Services Web site.  You can sign up for the listserv via www.http://NGSMedicare.com.  Select your line of business (A, B, HH&H, FQHC).  Select E-mail Updates under Publications.  The Web site offers up-to-date information on the following important topics:
Source: ebixinc.com

NGS to Administer Medicare Claims Payment in New York (S U P R A S P I N A T U S)

NGS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in the two states. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.
Source: nysbar.com

Transition to NGS as J6 MAC

, 2013 and affects all home care providers that currently bill claims under contractor number 00450. At the time of the change, you will need to ensure that you change the contractor number on your EDI claims to 06001. Please note that if you bill through the Direct Data Entry (DDE) system then you will not need to change the contractor number on your claims.
Source: glmi.com

NGS Announces Physical Therapy Edits on Frequency and Duration

In accordance with the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM), Medicare Benefits Policy Manual, Publication 100-02, Chapter 15, Section 220.2 PDF External (1 MB), services rendered must be reasonable and necessary. In order for a service to be covered, it must have a benefit category in the statute and it must not be excluded. Therapy services are a benefit under Section1861 of the Act. Consult the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.1 PDF External (233 KB) for full descriptions of reasonable and necessary services.
Source: nancybeckley.com

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September 23, 2013

Bloomberg Law: Just the RAC Facts: Controversial Program Roots Out Fraud, Waste in Medicare

Posted by:  :  Category: Medicare

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As the cost and sophistication of care increases, Medicare fraud is becoming more widespread. In July, the Department of Justice settled a multi-million dollar fraud case with 55 hospitals across 21 states. The providers agreed to pay $34 million in fines after it was discovered they performed costly inpatient spinal surgeries—instead of outpatient procedures—on patients with osteoporosis in order to pad Medicare reimbursements (17 HFRA 621, 7/10/13).5 This settlement followed a 2012 case, in which 14 hospitals agreed to pay more than $12 million after they also performed inpatient procedures in order to bilk Medicare (16 HFRA 143, 2/22/12).6
Source: properpayments.org

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Medicare Plans vs Health Exchanges

About Express Scripts Express Scripts manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science℠, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.
Source: bloomerboomer.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

2013 Cost Projections for Medicare Programs

This week’s charts compare the Medicare cost projections under current law assumption with more realistic alternative assumptions measured as a percentage of the economy. The Medicare Trustees’ Report presents an illustrative alternative scenario that assumes a continuation of the historical pattern of SGR overrides; the report also shows an another alternative scenario in which, in addition to an SGR override, certain controversial elements of the 2010 Affordable Care Act (ACA) are either scaled back during the period from 2020 to 2034 or eliminated altogether.
Source: mercatus.org

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

Nursing homes beneficial for Medicare program, researchers find

Researchers from the University of Minnesota School of Public Health and the University of Hong Kong looked at Medicare and Medicaid expenditures for seniors covered by both government insurance programs, and compared that with expenditures for those covered by only one. The team was looking for information about how case mix and long-term care impacts spending, and for evidence of “de facto cross-subsidization” of Medicare and Medicaid.
Source: mcknights.com

A guide for new and first

With a new class of medical residents beginning their training, and residents and Fellows graduating from their programs every July, it’s important that our critical partners in the delivery of healthcare have the tools they need to understand federal program requirements.  At the Centers for Medicare & Medicaid Services (CMS) we have a comprehensive strategy to reduce fraud, waste and abuse that is designed to target risk – that means as we make it harder for bad actors to enroll or bill in our systems, we are always evaluating how to make it easier for legitimate physicians and other providers to participate in Medicare and care for beneficiaries.
Source: cms.gov

Social Security and Medicare Programs Remain on Unsustainable Paths

The data show that both Social Security and Medicare programs remain on unsustainable paths. Even these grim numbers may be too optimistic because the expected revenue or cost savings assumed under current law may never materialize. In fact, a section at the end of the Trustees Report called “Statement of Actuarial Opinion,” (p. 273) makes that point very clearly. Paul Spitalinic, the acting chief actuary of the program, explains that “current law would require a physician fee reduction of an estimated 24.7 percent on January 1, 2014—an implausible expectation.”
Source: mercatus.org

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September 23, 2013

FAQ: What is Medicare Supplement (Medigap) Insurance?

Posted by:  :  Category: Medicare

Medicare Supplement Insurance, also known as Medigap or MedSup coverage, complements Original Medicare (Medicare Part A and Part B) by filling in the coverage gaps of some health care costs that are not covered under those plans. Medigap is an optional program, which means that Medicare does not pay for any part of this coverage. Medigap coverage is purchased through private insurance companies at the cost of the beneficiary.
Source: ehealthmedicare.com

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

Medicare Supplemental Insurance Plans

While this is a question we get all the time there is no standard answer to the question. The cost of a Medicare supplement plan depends on four factors. Those factors are age of the applicant, gender, health, and location. If you are just turning 65 or going on Medicare Part B for the first time then you have the advantage of being in Open Enrollment. Open enrollment means that for six months you have an opportunity to get Medicare supplemental insurance without a health exam. So if you have a chronic illness or are a smoker you can get the same rates as anyone else during this period. It is our privilege to help seniors make these important decisions about a Medigap plan. If you have any questions or if there is any way we can serve you please use the “contact us” link at the bottom of this page and either call or email us.
Source: choosingamedigap.com

House Republicans criticize rich Medigap plans

The authors — House Energy & Commerce Chairman Fred Upton, R-Mich.; Rep. Joe Pitts, R-Tenn., chairman of the Energy and Commerce health subcommittee; House Ways and Means Chairman Dave Camp, R-Mich.; and Rep. Kevin Brady, R-Texas, chairman of the Ways and Means health subcommittee — say the commentary will be the first in a series of Medicare reform papers.
Source: lifehealthpro.com

International Travel Concerns for Seniors with Medicare…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

What Exactly Is A Medicare Supplement Plan In Arizona State

The one is nicer? The short decision is it depends on your wishes. You should take on if you have medical issues where require expensive treatment method. Second, you really should consider how usually you travel along with if you system to move eventually. Thirdly, you require to weigh your actual options from an income basis. Do you will want unhindered access to actually medical care, or maybe are you wanting to spend a certain time shopping you are options to some?
Source: geocubes.com

Benefits Of Medigap Insurance

There are important things clients should understand before attempting to purchase Medigap. To get Medigap, Part A or Part B Medicare is required. Applying for Medigap is possible if you already have a Medicare Advantage Plan; before your Medigap policy starts, however, you must cancel the Medicare Advantage Plan. Paying a private insurance company each month is possible; the payments can cover the Medigap policy and the Part B plan that is paid to Medicare. If you want to get Medigap coverage for many people, each individual will need coverage; several policies must be purchased because Medigap just covers one individual. Finding a provider is not tough; many insurance companies will offer Medigap; search for companies that are licensed within your state. When clients buy Medigap; they get a guarantee; most standardized policies are renewable. If clients have health issues, they can still renew. Some coverage polices are different depending on the year the policy was sold. Policies offered years ago covered prescription drugs; policies sold after 2006, however, does not cover prescription drugs. Clients that need prescription drug coverage must consider Medicare Prescription Drug Plan (Part D). A Medicare Medical Savings Account Plan is not allowed if you want a Medigap policy; it is illegal.
Source: deborahserani.com

Benefits of Medicare Supplement Plans

Just because an individual is enrolled in a medical supplement insurance plan does not mean that they cannot keep the same doctors, as they are still considered to be under the Medicare program. In short, they will not lose any of their Medicare protection or rights under through medicare supplement plans.For example, while using medical supplement insurance, Plans A through G will have higher premiums, but will have limited out-of-pocket costs. Medicare Plan F is the most expensive medigap plan but it is also the most popular plan among participants because it covers all of the gaps left by Medicare. Plans K through N are known as cost-sharing plans that offer similar benefits at lower premiums, while the out-of-pockets costs will be higher. Other companies may offer additional benefits to individuals as well.
Source: dean2112.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

Understanding Medicare Supplemental Insurance

While Medicare covers many things, there are different regulations depending on the state. There are also limitations, such as the length of time a person can stay in a hospital or nursing home, medical problems outside the United States, and so forth. That is why many people purchase additional Medicare supplements, also called Medigap, from a private insurance company.
Source: askamydaily.com

Key Things to Know About Buying Medicare Supplemental Insurance

Additional benefits vary according to the plan selected. These benefits include a set amount of coverage for skilled nursing facility charges up to 100 days, and coverage of certain Medicare Part A deductible charges. Since 2006, Medicare Supplemental Insurance plans do not include prescription drug coverage as part of their benefits, and individuals requiring such coverage should investigate joining a Medicare Part D Prescription Drug Plan. Individuals should also be aware that Medigap plans generally do not cover such costs as private-duty nurses, dental or eye care, eyeglasses, hearing aids or long-term nursing care costs. Consider switching over to a Medigap Advantage Plan if prescription drug coverage is required.
Source: weatheringthefinancialstorm.org

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