Medicare Open Enrollment Period Begins Oct. 15, 2013

Posted by:  :  Category: Medicare

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

Video: Medicare Part B Cost and Late Enrollment Penalty

Ask The Experts: Retirement

Q. I’m older than my spouse, and am already on Medicare Part A. I have Blue Cross/Blue Shield for Part B, and that is our primary family insurance. When I retire, I understand that I must take Part B of Medicare (I’ll be 73 when I retire). However, my spouse will only be 61 — too young for Medicare — so I plan to continue BC/BS family plan. Do I still need to sign up for Medicare Part B even though I’ll keep the BC/BS? Or should I just keep the BC/BS for single coverage (for my spouse)?
Source: federaltimes.com

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

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

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

How Can I Qualify for Medicare Before I’m 65?

Those younger than 65. Unfortunately, there are limited ways to get Medicare if you’re under 65. You can qualify for Medicare if you are approved for disability benefits from Social Security or the Railroad Retirement Board. However, there is a 24-month waiting period after you become entitled to disability benefits before you can get Medicare. You can also get Medicare coverage if you have end-state kidney/renal disease (ESRD). (For ESRD, you or your spouse need only be “currently insured” with Social Security. If you or your spouse earned six credits in the three years before turning before turning 65 or dying, you are currently insured.)
Source: nolo.com

Medicare and Reform: 50 States of Confusion

Closes the Coverage Gap: The Coverage Gap — also known as the donut-hole — is the portion of a Part D plan where beneficiaries pay a higher portion of their medication costs until they reach a certain dollar amount, known as an out-of-pocket maximum. Since 2010, with the help of pharmaceutical manufacturers, CMS has lowered the copayment amounts on brands and generics. Since this change began in 2010, beneficiaries have saved $1,000, on average. By 2020, the Coverage Gap will go away completely. Surprisingly, 77% do not know that the Coverage Gap is in the process of closing due to reform and are unaware of the current savings.
Source: express-scripts.com

Present Tense Magazine.org

Different Medicare plans exist based on different functions of the health care system. People who have the best Medicare Advantage plans have their health coverage paid for by the federal government. The rest of Medicare beneficiaries enroll in what is known as a single-payer health care system. As you consider the choice between different plans, especially any Medicare Part B supplemental plans, here are five facts to keep in mind,
Source: presenttensemagazine.org

Medicare Late Enrollment Premium Penalties

One way to avoid having to pay Part D penalties is to sign up for a Part D drug plan as soon as you become eligible. Or, you can delay enrolling in Medicare Part D without penalty, but only if you have had other prescription drug coverage at least as good as Medicare. This is known as credible coverage. If it’s been more than 63 days since you’ve had creditable coverage, then the penalty may apply. For each month you delay, you may have to pay an additional 1% of the average premium per month. You will pay that penalty for as long as you’re enrolled in a Medicare Part D plan.”
Source: mutskoinsurance.com

Sightings Over Sixty: Tips for Enrolling in Medicare

. This part of Medicare is actually something separate. It is a Medicare Advantage plan. This is an insurance plan supplied by a private company that works directly with Medicare. The Medicare Advantage plan consolidates all your other Medicare options into one overall plan.      So, with a Medicare Supplement plan (which does not count as Part C), you pay separately for Part B, Part D, for the supplement plan itself, and for any other insurance you might want — like a dental insurance plan, for example.      With a Medicare Advantage plan, or Part C, you pay one bill that includes your drug plan, and also typically offers a dental plan. However, the Medical Advantage plan is either an HMO plan, or a PPO plan. With an HMO, you must go to a doctor in the insurance company’s network. With a PPO you also go to a doctor in network. You can go to a doctor that’s out-of-network, but the insurance will only cover a smaller portion of the bill that Medicare doesn’t pay — leaving you exposed to unknown and perhaps very high medical costs.      Advice: If you want the convenience of a Medicare Advantage plan, and you want to stay with your current medical practice, you should call your doctor’s office and make sure the doctor is in the network of that particular plan.      Personally, when I was signing up, I thought I’d choose a PPO plan. I’d go to my doctor on a regular basis. But then, if I needed some kind of specialist that was out-of-network, I could go, and I’d just have to pay more.      Then I found out that my current medical group does not accept the Medicare Advantage plan of my old insurance company, which was HIP. That would mean I’d be paying out-of-network fees every time I go to the doctor.      It didn’t make sense to me that my medical group would accept regular HIP; but not accept HIP Medical Advantage. But that’s the policy. And my medical group is the biggest, most comprehensive medical group in my area. I did not want to change.      Then I researched the AARP offering, through United Healthcare. My medical group accepts the United Healthcare Medicare Supplement plan. But, for some reason, it does not accept the United Healthcare Medicare Advantage Plan. Therefore, again, with the Advantage plan every time I’d go to the doctor, I’d be paying out-of-service fees.      So I chose the AARP United Healthcare Medicare Supplement Plan. I do not have my insurance wrapped up into one policy. I pay a separate bill each, for Medicare Part B, Medicare Part D, and the Medicare Supplement plan. And then, since my supplement plan does not include dental, I purchased a separate dental plan through AARP, with yet another bill, for another $40-some per month.      I pay four separate bills. The good news is that altogether they are about a third less than what I was paying through my old medical insurance plan, as of two months ago.      I have yet to actually use Medicare. I haven’t been to the doctor yet. I sure hope the process becomes a little easier.      Meantime, I know there are lots of people with more Medicare experience than I have. So if I’ve got anything wrong here, I hope you will correct me. Or if there’s anything to add, which could help the Medicare neophyte, I hope you won’t hesitate to append your advice. Thanks and good luck!
Source: blogspot.com

Regulations to Consider Before Opting Out of Medicare

Posted by:  :  Category: Medicare

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There are three basic Medicare enrollment options for physicians: 1. Participating providers. A participating provider is enrolled in the Medicare program and accepts assignment on all Medicare claims. Accepting “assignment” means that the physician bills Medicare directly and accepts as full payment for a rendered service 80 percent of the Medicare fee schedule amount; plus 20 percent of the Medicare fee schedule amount from the patient (or the patient’s secondary insurance). A participating physician must accept assignment for all Medicare covered services; however, the physician can limit the number of Medicare patients he or she treats. 2. Non-participating providers. In many ways, non-participating providers are similar to participating providers. Both are enrolled in Medicare, both bill Medicare directly for services, and Medicare pays both 80 percent of the approved charge for a rendered service. There are, however, some important differences between these providers. For non-participating physicians, Medicare sets the approved amount for a service at 95 percent of what is approved for participating physicians. Accordingly, if Medicare makes payment based on an approved charge of $100 for a participating physician, Medicare will base payment for a non-participating physician on a charge of $95 for the same service. Non-participating physicians, however, are not limited to accepting only $95. They can charge up to 115 percent of Medicare’s allowed charge. For example, for a service with a Medicare-approved charge of $95, a non-participating provider can charge a total of $109.25. The provider would bill Medicare for $109.25 and Medicare would pay $76 (80 percent of the $95 Medicare-approved fee). Even though the physician would bill Medicare for this service, the payment would be made to the patient, and the physician would need to collect the amount directly from the patient. The patient or secondary-payer would be responsible for $19 (20 percent of the $95 Medicare approved fee). The remaining amount ($14.25) would be billed to the patient. 3. Opt-out providers. Physicians opting out of Medicare bill patients directly for services otherwise covered by Medicare. Unlike both a participating and non-participating provider, physicians who have opted-out of Medicare may not bill Medicare for services (with the limited exception of some emergency services), and Medicare beneficiaries receiving services from an opted-out provider may not seek reimbursement from Medicare. To privately contract with a Medicare beneficiary, a physician must enter into a written, private agreement with the patient that meets specific requirements, as set forth by Medicare regulations.  In addition to the private agreement, the physician must file an affidavit with Medicare that also meets certain Medicare regulatory requirements. The affidavit must be filed no later than 30 days before the first day of a calendar quarter. A physician has 90 days after the start of the opt-out period to revoke his or her decision and remain enrolled in Medicare. After that time, the opt out is effective for two-years.
Source: physicianspractice.com

Video: clinical chart documentation review crosswalking CMS Medicare 2010 regulations.mov

New Medicare Regulations for Durable Medical Equipment

Starting October 1, new Medicare regulations will require nurse practitioners to obtain a physician’s documentation on the patient’s medical record that a face-to-face encounter with that patient has taken place within the six months prior to the order of certain durable medical equipment (DME).  The American Association of Nurse Practitioners (AANP) not only objects to this burdensome documentation requirement but also warns that the list of items impacted by the regulation are routinely ordered items such as home glucose monitors, oxygen, respiratory equipment such as nebulizers, bed padding, and basic wheelchairs. Click here to review a full list of the items.
Source: drnpa.org

Medicare Insurance And Medicaid Rules And Regulations

Called regenerative braking . if you include Plan J? If you already have plan J, you can preserve it if such as or you will be able to switch to a new medicare supplement Plan and try to save money. If you are planning to switch to one of several newMedicare Supplement Tips such as Strategize N or Intend M, you could possibly qualify for one guaranteed issue period which means you will not have to explanation any health matters and will be authorized into the new plan regardless any sort of pre-existing health conditions. However, if you wish to keep a comprehensive plan pertaining to example Medicare Supplement Plan F, you seem required to clear-cut conclusion a series to do with easy health examination questions prior to getting qualification. However, if you are in good health you will likely be able to save lot of moolah.
Source: macola.info

CMS Releases FY 2014 Medicare Payment Regulations for Inpatient Psychiatric Facilities

CMS’s Rehabilitation, Psychiatric, and Long Term Care market basket index, which reflects changes in the prices of goods and services in IPFs, inpatient rehabilitation facilities and long term care hospitals, projected a 2.6 percent price increase.  However, the market basket increase was reduced by a 0.5 percent multifactor productivity adjustment and an additional 0.1 percent adjustment, both required by the Affordable Care Act.  In addition, the high cost outlier threshold for Fiscal Year 2014 resulted in a 0.03 percent increase.  Accordingly, the actual payment increase will be approximately 2.3 percent.  CMS estimates that it will spend an additional $115 million for inpatient psychiatric care because of the payment rate increase.
Source: jdsupra.com

What is the difference between Medicare Certified agencies, Home Hospice Care and Private Home Care?

Medicare Certified Home Health and Hospice agencies are amazing services that are available to most US citizens, paid for by either their private insurance, Medicare or Medicaid. If not, then many of these same services may be purchased privately. Nurse Next Door supports those efforts and aims to minimize the risk of hospital readmission by doing everything that these agencies are unable to support due to regulatory restrictions and policy guidelines.. Together , Nurse Next door , Medicare certified agencies and Hospice programs can work on behalf of those in need to deliver the best possible care.
Source: nursenextdoor.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

Feds Renew State’s Medicare Extension, Netting Millions for NJ Hospitals

“New Jersey is home to some of the nation’s finest hospitals. However, operating a hospital in our state is extremely expensive and without this policy New Jersey hospitals face a significant disadvantage when compared to those in neighboring states,” Menendez said. “The announcement is proof that CMS recognizes the unique set of circumstances facing New Jersey hospitals and is willing to provide them reimbursements reflecting that.”
Source: njspotlight.com

The Tennessean: Vanderbilt Medical Center hit with Medicare fraud suit

“In reality, Vanderbilt has used the VPIMS to maximize its false billing practices by taking advantage of its remote access features to schedule attending physicians to be in multiple places at once, while continuing to bill their services as if they were actually present and personally performing the services at each place. VIPIMS’ purported improvements in billing efficiency are, in fact, largely a function of Vanderbilt’s development of mandatory default software settings that require its physicians, in all instances, to document that they meet Medicare’s conditions for payment.”
Source: properpayments.org

On private insurance, but under Medicare Regulations. Anyone else encounter this?

I also like to point out that I think that the whole issue is ripe for a class-action suit, making decisions about treatment without medical contact, cutting medical records, etc. The “damages” aren’t huge on a case-by-case basis but I suspect they could be quantified. It also would help a case that we don’t really care about $$$$ as much as getting coverage, in which case the only people making money on it would be the attorneys, which would likely enhance their interest in the case. I suspect that the Medicare guidelines and the weak and conservative AMA guidelines for supply needs stem from budgetary shortfalls but I am certain that were the issue to be explored, there’s a significant probability that actionable graft and corruption that would be a hook for the case.
Source: tudiabetes.org

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

Posted by:  :  Category: Medicare

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

Video: How to Apply for Medicaid

Berkeley County Sheriff’s Office Warns Of Medicare Scam

The Berkeley County Sheriff’s office says they have received 15 complaints in the last three days about people with heavy foreign accents calling homes and saying they are with Medicare and they need to update information.
Source: tv3winchester.com

Michigan house call firm locations tied to Medicare investigation, arrests

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Dementia residents with Medicare managed care plan less likely to be hospitalized, JAMA finds

Nursing home residents with advanced dementia who were covered under a Medicare managed care plan were more likely to have a do-not-hospitalize order and less likely to be transferred to a hospital, a new study finds
Source: naap.info

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

Breitenfeldt Group: Offering simple Medicare solutions

Some of the things to consider include premium costs, benefits, provider choice, prescription drugs, pharmacy choice, convenience, travel and quality of care. What will you pay out of pocket? Are extra benefits available, like eye  exams or hearing aids? Does your doctor accept the plan? Do you spend a part of each year in another state? What will your prescription drugs cost? What pharmacy can you use? Do you have or are you eligible for other types of coverage? Do you qualify for extra help? These are some of the questions that will be answered as your Medicare “puzzle” is assembled.
Source: srperspective.com

How Likely Are Physician Offices to Accept Medicare and Medicaid?

SK&A released its report titled, “Physician Office Acceptance Government Insurance Programs,” which showed 83.6 percent of medical providers accept Medicare and 67 percent accept Medicaid, though a decline may be imminent. The Patient Protection & Affordable Care Act will give 30 million Americans access to healthcare, many on Medicaid. But 31 percent of physicians said they would not accept new Medicaid patients, according to a National Ambulatory Medical Care survey. SK&A’s survey of 271,451 office-based physicians found larger, affiliated practices have higher Medicare and Medicaid acceptance rates, while smaller, non-affiliated practices have lower rates. Offices with daily volumes greater than 31 cases had an acceptance rate of 85.5 percent for Medicare and 69.6 percent for Medicaid. Also, healthcare system-owned and hospital-owned practices are more likely to accept Medicare, at 89.1 percent, compared with non-hospital or healthcare system-owned practices, at 82.7 percent. Medicaid acceptance is about 83 percent for hospital or healthcare-owned practices and only 64 percent for non-hospital or system owned. The top specialties accepting Medicaid are dialysis, critical care medicine and nephrology. The lowest acceptances rates come from bariatrics, occupational medicine and holistic medicine. More Articles on Revenue Cycle: Fitch: Non-Profit Hospitals May See Some Stability in 2013 Physician Groups Gear Up to Fight for SGR Repeal University Hospitals’ Fundraising Campaign Reaches $1B Goal
Source: beckershospitalreview.com

Former Hospital Administrator Receives $2,160,000 For Exposing Medicare Fraud

Dubuis Health System and Southern Crescent Hospital for Specialty Care, Inc. (Southern Crescent) have agreed to pay the United States $8,000,000 to settle allegations that they submitted false claims to Medicare.  Dubuis Health System manages long-term acute care hospitals in multiple states, including Southern Crescent.  Southern Crescent is a long-term acute care hospital located in Riverdale, Georgia.
Source: barrettlawofficetn.com

Promoting Integrity in Medicare Act of 2013 will close in

On the other hand, physician ownership is associated with higher volume; studies by the Commission and other researchers have found that physicians who furnish imaging services in their offices order more imaging than other physicians (Baker 2010, Hughes et al. 2010, Medicare Payment Advisory Commission 2009a). In addition, several types of imaging are usually not provided on the same day as an office visit, which raises questions about patient convenience. Rapid volume growth contributes to Medicare’s growing financial burden on taxpayers and beneficiaries, leads to concerns about the accuracy of physician fee schedule payment rates, and raises questions about inappropriate use.
Source: pathologyblawg.com

Is Social Security Income Taxable?

Posted by:  :  Category: Medicare

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To determine if your elderly parents (or yourself) will have to pay taxes, you first must determine how much income they are bringing into their home. Just because your parents have retired from their regular jobs doesn’t mean that they aren’t making income from other places, such as dividends and interest. In addition, some people may still work in their retirement years or become self-employed to make a little extra cash.
Source: taxbrain.com

Video: Social Security Disability tip: Functional Report Forms -3d parties

Don’t Destroy Your Social Security Disability Claim By Failing to Accurately Complete the Work History Report

1. Job stress 2. How often you interacted with coworkers, supervisors or the general public 3. The number of scheduled breaks you were allowed during full time work 4. Your employers tolerance for tardiness, unscheduled breaks or unscheduled absences 5. The degree of attention or concentration required to perform the work task 6. Any tasks that required or relied on concentration 7. Type of instructions that you were required to remember, understand, and perform 8. Time requirements or production requirements 9. How long were you required to sit at one time without a break 10. Any tasks that required your undivided attention and concentration
Source: caveylaw.com

What are the ways to apply for a Social Security card in the U.S.?

If you are applying for an original card, you must have two documents to prove your identity, your age, and your U.S. citizenship OR you work-authorized immigration status – these two documents are preferred to be either U.S. hospital record of your birth, religious record showing your age and date of birth, your U.S. passport, and/or your U.S. driver’s license. If you are applying to replace a card, you must only provide documentation to prove your identity.
Source: wordpress.com

Evidence Social Security Requires for Mental Disabilities

Social Security is required to look at all of your relevant medical records for at least twelve months before the date of your application for benefits. When you complete your application forms, you will list all of your treatment providers (like doctors, counselors, clinics, and hospitals). Social Security will ask you to sign its Authorization to Disclose Information (SSA-827) so that the agency can get your records from your treatment providers, if you have not already submitted them. While Social Security has an obligation to help you get all of your medical records, submitting them yourself will help you avoid delays in your case.
Source: disabilitysecrets.com

Workers & Retirees to Form Human Chain to Protest Chained CPI

The Chained CPI would change the way cost-of-living adjustments are calculated for Social Security, veterans and other federal benefits, and studies show that the proposal would take tens of thousands of dollars out of the pockets of retirees who need it the most. In honor of the Independence Day holiday, seniors and people with disabilities who rely on these programs for their own fiscal and personal independence will celebrate Congresswoman Waters be gathering to hitting the streets to defend the social safety net from schemes like Chained CPI.
Source: launionaflcio.org

Be careful in completing the Social Security Function Report

The SSA also uses function reports to determine whether claimants’ statements about the limiting effects of their condition are consistent with the jobs that they say they can no longer do. For example, if you are able to sit in church for three hours but testify that you cannot sit at all for more than 30 minutes on the job, there is an inconsistency which the judge may use to deny your claim.
Source: croyandtimms.com

Richmond Virginia Social Security Disability Lawyer Advice: Carefully Complete the Prior Work Form

Once you file your initial application for Social Security Disability benefits, Social Security will ask you to complete a prior work form.  This is an important form.  Remember, in order to receive disability benefits, you must prove that you are not capable of doing your past jobs.  Take your time when completing the prior work form and include as many details as possible.  Make sure to write down the heaviest weights you had to lift and the extremes of how much you had to walk, stand, push, and pull for each of your past jobs.
Source: cpollardlaw.com

How to Apply for a Social Security Number

Applying for a social security number in the USA is free and only requires completion of Form SS-5: Applicationfor a Social Security Card; however, relevant supporting documentation must also be submitted with the social security application. As legislation is always subject to change, and there are often additional requirements for certain categories of social security applicants, it is advisable to contact a local social security office before sending in an application for a social security card.
Source: suite101.com

WHAT DO I DO IF MY SOCIAL SECURITY DISABILITY REQUEST FOR RECONSIDERATION IS DENIED?

When you complete the Request for Hearing form, you will see the question asking  whether you wish to appear at a hearing.  Make sure that you mark the box that you want a hearing in front of a Judge.  This is the only opportunity you will have to actually face and speak to the person who will award or deny your claim.  If you choose not to appear, the Judge will  simply review the file and make a decision.  The Judge will not have an opportunity to ask you questions and hear from you how your impairments affect you and prevent you from working.
Source: scholnicklaw.com

IRS Exposes Social Security Numbers Online

As Malamud clarified, none of these forms explicitly or directly ask for Social Security Numbers. However, sometimes applicants attach to these forms other tax documents, such as their SS-4, that do ask for Social Security Numbers. The SS-4 is an application form through which individuals may request an employee identification number (EIN). The IRS does require that applicants provide their EIN in order to achieve 527 status, but they are not required to attach the SS-4 form. Only the number itself is necessary. Malamud claimed that applicants attach such documents in an attempt to more concretely prove the legitimacy and accuracy of the information they are providing as part of their 527 filings, despite the fact that there is no need to do so and, furthermore, the IRS urges applicants not to do so.
Source: threatpost.com

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September 26, 2013

Don’t Lose Control or Access to Your Assets

Posted by:  :  Category: Medicare

What will happen if you get sick or injured? Who’s in Control of You? Will you have a healthcare agent that can step up and manage your medical needs? Who controls your stuff? The State of Nebraska has a plan for you. It’s called a Guardianship and/or Conservatorship. A judge will decide who takes care of you and your stuff. Guardianship and Conservatorship proceedings are public, expensive and hard to manage. They tend to divide a family and create hard feelings that can last for many years.
Source: nebraskamedicaidlawyer.com

Video: Nebraska Medicaid Trying To Silence Me At Any Cost,Even My Life..wmv

Chadron resident faces $1.3M judgment for Medicaid fraud

According to the Attorney General’s office, Miller received payment for nearly $47,000 in Medicaid services never rendered. She also received $430,000 for Medicaid services without providing substantiation documentation. The court ordered triple civil damages in accordance with state law.
Source: nebraskaradionetwork.com

2013 AARP Survey of 18+ Nebraska Residents on Medicaid Expansion

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do
Source: aarp.org

Nebraska, Florida Contemplate Elements Of Health Law’s Medicaid Expansion

The Associated Press: Medicaid Backers Will Add Safeguards To Bill Supporters of a proposal to expand Medicaid in Nebraska said they’re willing to include cost safeguards within the bill, including a mandatory review of the program if its expenses were to skyrocket and a possible requirement that the state withdraw if the federal government fails to fund it as promised. Sen. Jeremy Nordquist of Omaha told The Associated Press that he and other lawmakers plan to float the idea Tuesday when they return to the Capitol for a long-awaited debate on Medicaid expansion (4/15).
Source: kaiserhealthnews.org

My stories: Nebraska Medicaid Application

Payday loans are cash advances and the nebraska medicaid application. The eastern side of the nebraska medicaid application is still number one in the nebraska medicaid application a Nebraska football legend, too. Both of these games depending on the nebraska medicaid application a serious decision. The person who you imagine you might be a ranching and farming State and the nebraska medicaid application. He also received Big 8 including interesting offers from Colorado, Kansas, and Northwestern. But Nebraska won. The Bill Jennings group had the nebraska medicaid application a survey in 1990 registered higher levels of radon than the nebraska medicaid application is based on their site that they may also choose any five numbers from a scabbard on his teeth was a great athlete because he is still number one in the nebraska medicaid application of the nebraska medicaid application in Omaha and the nebraska medicaid application. Nebraska also won the nebraska medicaid application a couple, romantic destinations in Nebraska is booming economically. There has never been a better time to use if a problem should occur. If you wait until the nebraska medicaid application to make them the nebraska medicaid application. By making them worth looking into when you are unable to pay an additional fee to avail the nebraska medicaid application over option.
Source: blogspot.com

Medicaid Expansion in Rural Nebraska

“These reports are particularly interesting in how they confront the conventional thinking behind much of the opposition to Medicaid expansion,” said John Crabtree with the Center for Rural Affairs. “Those who will benefit from the new Medicaid initiative are working people, many of them living in small town Nebraska and working at a small business, perhaps right on Main Street.”   “They are neighbors, friends and family… and thousands of them have sacrificed in order to serve our country in the military. As we debate access to health care, I think it is vital that we recognize who will fall through the cracks if we fail to move Medicaid expansion forward.”   John Crabtree, Center for Rural Affairs   According to a report by the Urban Institute, Nebraska has approximately 6,600 uninsured veterans, along with 3,600 uninsured spouses of military veterans. Moreover, the report estimates that over 2,000 of those veterans have incomes under 138% of the Federal Poverty Level, meaning they would be eligible to enroll in the new Medicaid initiative if implemented in Nebraska.
Source: cfra.org

Heineman says Nebraska Medicaid Bill ‘Should Not Pass’

KOLN-TV Call: (402) 467-4321 Toll-free: 1-800-475-1011 840 North 40th Lincoln, NE 68503 Email: info@1011now.com KGIN-TV Call: (308) 382-6100 123 N Locust Street Grand Island, NE 68802 Email: kgin@1011now.com KSNB-TV Toll free 888-475-1011 123 N. Locust St. Grand Island, NE 68802 Email : ksnb@1011now.com
Source: 1011now.com

Nearly 200 Dropped from Nebraska Insurance Program

The views expressed in comments published on NorthPlattePost.com are those of the comment writers alone. They do not represent the views or opinions of Eagle Communications or its employees. Comments are automatically posted live; however, NorthPlattePost.com reserves the right to take them down at any time at the discretion of the Editor. Be respectful….
Source: northplattepost.com

Medicaid Bill Supporters Rally at State Capitol

KOLN-TV Call: (402) 467-4321 Toll-free: 1-800-475-1011 840 North 40th Lincoln, NE 68503 Email: info@1011now.com KGIN-TV Call: (308) 382-6100 123 N Locust Street Grand Island, NE 68802 Email: kgin@1011now.com KSNB-TV Toll free 888-475-1011 123 N. Locust St. Grand Island, NE 68802 Email : ksnb@1011now.com
Source: 1011now.com

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September 26, 2013

Medicare Forecast: Solvent Until 2026, Though Baby Boomer Costs Loom

Posted by:  :  Category: Medicare

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Kaiser Health News: Slowdown In Medicare Funding Extends Trust Fund The Medicare spending projections also encompass areas of current law that are not likely to remain, such as a 25 percent payment cut for Medicare physician services scheduled to take effect on Jan. 1 that trustees say “is highly unlikely.” Trustee Robert Reischauer said it would be a mistake to make too much of the two-year extension on the life of the Medicare hospital trust fund. The Medicare projections involved a lot of uncertainty, he said, both on the legislative front — Congress will likely stop the scheduled Medicare physician payment cut, for example — and from the cost impact that new technologies, drugs and medical devices will have. Those “historically have tended to push up costs,” he said (Carey, 5/31). The New York Times: Outlook for Medicare Has Improved a Bit, U.S. Estimates The [health] law trimmed Medicare payments to many health care providers on the assumption that they would become more productive. Another factor, officials said, is the Budget Control Act of 2011, which calls for reductions of roughly 2 percent in projected Medicare spending from 2013 to 2021. … The slowdown in Medicare spending has broad implications for the federal budget and the economy. “In recent years,” said Douglas W. Elmendorf, the director of the Congressional Budget Office, “health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated.” (Pear, 5/31).
Source: kaiserhealthnews.org

Video: Introduction to Medicare Cost Reports

CONVERSABLE ECONOMIST: Geographic Practice and Cost Variations in Medicare

A close look at the underlying spending patterns reveals that 73% of this variation across the geographic areas is due to a single category of spending: specifically, spending for “post-acute care”–that is, the follow-up care after hospitalization–and most of the rest of the variation is due to variation in acute (inpatient) care. These findings for Medicare are representative of a large literature showing that patterns of U.S. health care for all age groups vary considerably across cities and states. For example, the decision between heart surgery and treatment with blood pressure medications, or the proportion of mothers who have a C-section, or the choices about all kinds of minor surgery vary considerably across locations. There is often with no evidence that the area making the more expensive choice has better health outcomes, which suggests that if health providers in some areas could learn from those in other areas–or if health care reimbursement plans can be jiggered to reward certain choices and discourage others–overall health care costs could be reduced with little or no adverse effect on health. But not much is known along these lines so far. As the Institute of Medicine report notes, “By creating the Center for Medicare and Medicaid Innovation, the ACA [Affordable Care Act] generated a thousand pilot demonstrations of new payment models. It is too early to know which of these models will prove to control health care costs and improve quality.” Also, the author suggest: “Additionally, Congress should give CMS [Centers for Medicare and Medicaid Services] the flexibility to experiment with the mix of payment mechanisms, rates, and performance metrics that will align provider incentives with high-value care.” Given that rising health care costs and the geographic variations in health care use have both been well-known for several decades, the fact that experimentation with different payment methods “to align provider incentive with high-value care” is really just getting underway seems to me rather disheartening.
Source: blogspot.com

A Guide To the 2013 Medicare Trustees Report

Medicare’s HI trust fund, which finances hospital, home health following hospital stays, skilled nursing facility and hospice care services, is only one piece of a larger Medicare program and indeed represents less than half of total program costs. Like Social Security, Medicare HI is financed primarily by a tax on worker wages and can theoretically become insolvent if its obligations exceed its financial resources. But Medicare’s Supplementary Medical Insurance (SMI) trust fund has even greater expenditures and includes Medicare Parts B (physician, outpatient hospital, and general home health services) and D (prescription drug coverage). SMI has no projected depletion date because by statutory construction it is automatically provided with whatever general fund revenues it needs (beyond tax and premium income) to remain solvent. Thus financial strains in SMI are manifested not in projected insolvency but as rising pressure on the general federal budget.
Source: mercatus.org

Medicare Trustees Report Shows Lower Cost Growth Helping Medicare Financing

Medicare spending per beneficiary has grown quite slowly over the past few years and is projected to continue growing slowly over the next several years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, more slowly than the average rate of growth in the Consumer Price Index, and substantially more slowly than the per capita rate of growth in the economy.  Thanks in part to the cost controls implemented in the Affordable Care Act, spending is projected to continue to grow slower than the overall economy for the next several years.
Source: jaredbernsteinblog.com

Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and lower health care costs – with some estimates projecting hundreds of billions of dollars in savings over the next decade.
Source: kff.org

Report: Inaccurate Payments to Medicare Advantage Programs Continue to Cost Government Billions

A report by the U.S. Government Accountability Office (GAO) suggests the Medicare Trust Fund could save billions if the Centers for Medicare and Medicaid Services (CMS) would adjust payments for Medicare Advantage plans to more accurately reflect the health of those enrollees. The problem, according to the report, is Medicare pays Medicare Advantage plans a predetermined amount for each beneficiary based on risk scores, which are adjusted for health status. The methodology CMS uses to come up with the risk scores has led to overpayments to these plans. CMS has been working to correct the problem, but not enough. By more accurately paying for beneficiaries, the Medicare program would have saved between $3.2 to $5.1 billion in Medicare Advantage plan payments from 2010 to 2012, according to the GOA report. While Congress took action through the Affordable Care Act in 2010 to reduce excessive payments to private plans, CMS continues to use the risk score adjustment of 3.4 percent it used in 2010, ’11 and ’12. CMS officials have said they may revisit their methodology in the future. Recently, Energy and Commerce Ranking Member Henry A. Waxman, along with Ways and Means Ranking Member, Sander Levin, released an update to the GAO report. Waxman and Levin point out interesting inconsistencies in what the plans report. They say documented evidence shows that Medicare Advantage plans tend to report higher patient severity than is supported by medical records. The evidence also shows reported patient severity increases faster than for comparable patients in traditional fee-for-service Medicare. More information for Medicare fraud is located at the Nolan Auerbach & White website.
Source: medicare-fraud.net

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: kff.org

First in Series on Medicare DSH and Top Cost Report Appeal Issues

One key appeal rule change requires cost reports ending on or after December 31, 2008 to have all appeal issues included as Protested Items in Line 30 on Worksheet E, Part A.  Please ensure that your potential appeal issues are being preserved when you file your cost report.  It is also possible to file an amended cost report prior to the issuance of the NPR for that year.  If you protest more than one issue, please ensure that you are itemizing each issue and the impact.
Source: hallrender.com

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September 26, 2013

What happened to Highmark Medicare Services?

Posted by:  :  Category: Medicare

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

Video: Blue Cross Medicare Advantage – Popular Plan Options

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

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

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

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

The Delaware Libertarian: The Highmark footprint in Delaware is both deeper and wider than you think …

I have, of course, been going into great detail to explain the relationship between Highmark and MedExpress, and to lay out what appears to be the Highmark plan for establishing a monopoly on health insurance and even health care in Delaware. This is apparently worrisome to some of the leaders of Highmark Delaware, who appear to have become new followers of this blog, like President/CEO Timothy Constantine and (this title is not only a mouthful but quite unintentionally revealing) Senior Vice President for Provider Strategy and Integration Paul Kaplan. Well, I always welcome new readers, even aggrieved new readers. It is important right now to step back and take an even broader look at the overall Highmark empire, to include specifically the parts of that empire that impinge on Delaware. I will warn you at the outset that this is a long, LONG post, but if you actually care about free-market competition, monopolistic business practices, or government corruption, you need to read it all. What you have to know to begin with is that Highmark (the parent company) is a not-for-profit (no, I’m not kidding) corporation that includes in its holdings a fascinating mix of both non-profit and for-profit subsidiaries.  Time to read below the fold if you truly want to be informed: For example, Highmark controls (at least) the following not-for-profit entities: Highmark Health Services Highmark Blue Cross Blue Shield (Western PA) Highmark Blue Cross Blue Shield (Central PA) Highmark Blue Cross Blue Shield (West Virginia) Highmark Blue Cross Blue Shield (Delaware) The Highmark Foundation Alleghany Health Network (a hospital chain in PA) But to those we must add this (possibly incomplete) list of Highmark’s for-profit holdings: United Concordia (dental insurance) Davis Vision (managed care vision insurance) Visionworks of America (the nation’s second-largest chain of optometry stores) Viva International Group (eyewear manufacturing) Eye Care Centers of America HM Insurance (a re-insurer for workplace, low-benefit medical, disability, and other insurance) MedExpress urgent care centers (reportedly a 10% stake) By the way, as I was doing the final editing on this piece I discovered that I was wrong.  Highmark actually owns AT LEAST 35 subsidiary (and mostly for-profit) companies. Within Delaware, then, we need to note that Highmark controls the following: Highmark Blue Cross Blue Shield (Delaware) [the state’s largest insurer] MedExpress (five current centers; at least three more to come) Visionworks (one store in Wilmington) United Concordia Dental Insurance If you want to get a real glimpse of how Highmark reports its own strategy, you really have to look now further than Visionworks, which is now the largest American-owned chain of optometry stores, and second in size only to foreign-owned Lens Crafters. First, here’s the story of the great Visionworks consolidation: Visionworks is the name that eventually will be taken by all 600 or so of the retail vision outlets that Highmark operates across the 
Source: blogspot.com

Insurer Highmark selling Medicare services

Details of the deal were not disclosed in a joint news release from the two companies. The sale is expected to close in early January, and Highmark Medical Services will continue to operate as a separate organization.
Source: thedailyrecord.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

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

Highmark Health Services forms 'Accountable Care Alliance' in Western Pennsylvania

Stanford Hospital & Clinics (SHC) has named Pravene Nath, M.D., as its chief information officer and Christopher (Topher) Sharp, M.D., as chief medical information officer. Nath joined Palo Alto, Calif.-based SHC in September 2008 as CMIO and has served as its interim CIO since former CIO Carolyn Byerly left that position in January 2013 to form her own consulting firm called Platinum Advisory Services LLC.
Source: healthcare-informatics.com

HIGHMARK MEDICARE SERVICES FOLLOWS TENNESSEE

Coincidentally, just a few days after the Office of Inspector General announced the $3 million settlement of the credit balance case with the Tennessee cardiology practice, Highmark Medicare Services issued a bulletin reminding providers of their obligation to file the Medicare Credit Balance Detail Report 838. Let me remind you that part of the basis for the Tennessee settlement was that the provider groups maintain their records to conceal the credit balances. Hopefully, your internal records will agree with the Medicare Credit Balance Detail Report. The Highmark Medicare Services reminder can be accessed at:
Source: medlawblog.com

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September 26, 2013

FAQ: Seniors on Medicare don't need to apply to the health law marketplaces

Posted by:  :  Category: Medicare

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Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law’s changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, “which have already led to access problems for Medicaid enrollees.”
Source: nbcnews.com

Video: What Is Medicare Advantage?

Medicare Advantage plans to drop next year

Factors driving MA participation decline include “the continued phase-in of payment cuts enacted under the PPACA; modifications to the CMS risk adjustment model; implementation of new medical loss ratio requirements for MA plans; and application of the new health insurer fee,” Avalare Health said.
Source: benefitspro.com

AHIP Statement on Medicare Advantage

“While today’s announcement is good news for seniors and people with disabilities, we are concerned that Medicare Advantage beneficiaries may experience higher out-of-pocket costs and disruptions in their coverage when the ACA’s $200 billion in payment cuts are fully phased-in over the next several years.  These cuts will be compounded by the ACA’s new tax on Medicare Advantage coverage that is projected to increase costs for seniors in the program by $3,500 over the next ten years.”
Source: ahipcoverage.com

HHS on Medicare Advantage: Enrollment high, premiums low

Helping to increase enrollment in MA: The majority of beneficiaries (99.1%) have access to these higher-quality plans, according to HHS. The department expects the average number of plan choices will remain about the same in 2014 and access to supplemental benefits will remain stable.
Source: hmenews.com

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: kff.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

Kathleen Sebelius extends Medicare Advantage to same

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

The in box. TRIP and Medicare info from the IEA.

The state will be implementing a Medicare Advantage Plan for Medicare-eligible State Employees’ Retirement System (SERS) and State Universities Retirement System (SURS) participants pursuant to the recently settled AFSCME state employment contract. Since the state also administers TRIP, along with the health insurance benefits of SERS and SURS retirees, it believes that by shifting to this type of plan for all retirees that it can provide the same level of health care services while reducing costs through:
Source: wordpress.com

Medicare Advantage Fact Sheet

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

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

Learn About Medicare Advantage Plans

Medicare Advantage plans are health plans approved by Medicare and run by private companies like ConnectiCare. They are part of the Medicare Program and sometimes referred to as Medicare Part C. Inherent in their name, Medicare Advantage Plans can offer beneficiaries many advantages – cost savings, additional benefits and services and the convenience of having one health plan with one monthly plan premium.
Source: foxct.com

What Is Medicare Advantage?

In terms of coverage, Medicare Advantage Plans still provide Medicare Part A and Medicare Part B coverage. This means that individuals who choose Medicare Advantage Plans will still be provided with the hospital coverage and medical coverage that would normally come from Original Medicare, only their coverage will come through Medicare Advantage Plans. This differs from Medicare Supplement Insurance, also called Medigap, because Medigap policies simply pay for the costs that Original Medicare does not cover. MA Plans must provide for all of the services that Original Medicare covers except for hospice care. However, consumers who choose to use MA Plans will still be covered for hospice care under Original Medicare. Additionally, MA Plans always cover emergency and urgent care services.
Source: 360signals.com

UnitedHealth: Expect narrower Medicare Advantage networks

Gail Boudreaux, the company’s executive vice president, said during the earnings call that the company expects to sell coverage through Patient Protection and Affordable Care Act (PPACA) exchanges in about a dozen states in 2014 and sees the exchanges as a huge opportunity over the long term.
Source: lifehealthpro.com

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September 26, 2013

Preliminary Obamacare cost preview data released (with cost calculator)

Posted by:  :  Category: Medicare

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The Kansas City Star is pleased to provide this opportunity to share information, experiences and observations about what’s in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.
Source: kansascity.com

Video: Individual Health Insurance and Family Medical Plans: PART 4

New Cancer Insurance Checklist Helps Patients Choose a Health Insurance Plan

The Cancer Insurance Checklist is an easily downloadable form that helps you to organize all of your health care needs from prescriptions to doctor’s visits, compare health insurance plans in your state’s marketplace and offers guidance on the questions you should ask when deciding between different insurance plans. It provides a worksheet to help you detail all the costs associated with each plan and was designed to be used while evaluating plans and discussing your needs with a navigator or health care provider. The Checklist was created with cancer patients’ needs in mind to ensure all bases are covered when comparing health insurance plans. You can find more information and download the checklist at www.cancerinsurancechecklist.org.
Source: ovariancancer.org

Update: Here Are the Rates for the Arkansas Health Insurance Marketplace

Bradford said he hoped the release of the rates means that lawmakers will allow a $4.5 million contract to promote the insurance exchange to move forward. A legislative panel on Friday voted to delay approval of the contract, which would use federal money to pay for television, radio and newspaper ads as well as billboards and direct mail pieces between Oct. 1 and March 31. Lawmakers said they didn’t want to continue the marketing effort until they knew how much the insurance plans would cost.
Source: arkansasbusiness.com

GOP Unveils Yet Another Health Care Non

Anyway, that’s it. Same old, same old. You may now go about your business and ignore the latest healthcare non-plan from conservatives, just as you can ignore the latest tax reform non-plan from conservatives. In fact, why don’t you just take the whole day off?
Source: motherjones.com

Health insurance marketplace opens Oct. 1

The Employer Shared Responsibility Payment applies to some large employers who don’t offer insurance that meets certain minimum standards. For instance, if an employee’s share of premiums is more than 9.5 percent of his or her yearly household income, the coverage isn’t affordable. Companies can avoid the payment if the employee’s share doesn’t exceed 9.5 percent of their wages for the year. A health plan meets the “minimum value” requirement if the plan’s share of the total costs of covered services is at least 60 percent.
Source: csbj.com

Federal healthcare exchange, Obamacare, to cost Missourians ‘less than projected amount’

The Health and Human Services report shows, for example, that a 27-year old living in Missouri who makes $25,000 per year will pay $87 per month for the lowest cost bronze plan and $145 per month for the second lowest cost silver plan, taking into account tax credits. For a family of four in Missouri with an income of $50,000 per year, the lowest bronze plan would cost $72 per month.
Source: missourinet.com

Law removes a stumbling block to getting health

Circumstance: Laura and her husband, Jay, are auto mechanics and together they own Jay’s Professional Automotive, a car-repair shop in Renton. When they opened the shop in 1997, the couple went without health insurance. Then about two years ago, they applied for coverage. Jay was accepted, but Laura, who has a pre-existing health condition, was not.
Source: seattletimes.com

Affordable Care Act premium rates unveiled in Wisconsin

In Wisconsin, the average premium for the lowest-cost silver plan will be $344 and for the lowest cost bronze plan it will be $287. The average premium nationally for the second lowest cost silver plan will be $328 before tax credits, or 16 percent below projections based off of Congressional Budget Office estimates.  About 95 percent of uninsured people eligible for the Marketplace live in a state where their average premium is lower than projections.   And states with the lowest premiums have more than twice the number of insurance companies offering plans than states with the highest premiums.
Source: fox6now.com

House conservatives unveil health care plan

For years, I’ve criticized Republicans for not doing enough to promote free market health care reforms as an antidote to President Obama’s health care law. On Wednesday, the Republican Study Committee hopes to change this by unveiling a new health care bill that attempts to transform the system into a consumer-driven one.
Source: washingtonexaminer.com

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September 26, 2013

Utah Medicare Supplements

Posted by:  :  Category: Medicare

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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

Video: Medicare Quotes

Bloomfield's News on Money

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

Compare Quotes on Medicare Supplement Insurance

Each plan, A through L, has a different set of benefits. Each insurance company decides for itself which of the A through L policies it wants to sell. An insurance company must, however, sell plan A if it sells any other Medicare supplement insurance plan. The benefits in plans A through L vary, but they are the same for any insurance company. That is, plan A has a different set of benefits from plan B, but plan A has the same benefits no matter who sells it. However, different insurance companies can charge different premiums. So, while plan A has the same benefits no matter who sells it, different insurance companies can charge different premiums for a plan A policy.
Source: whitening-capsules.com

Understanding Medicare Insurance › Health Insurance Quotes

There are some additional requirements that need to be fulfilled apart from these basic requirements, but they’re plentiful and they depend entirely on the plan that you’re going to use. In order to find out what the requirements are, speak with your local social security administration office or visit Healthcare.gov for more information so that you’ll know exactly what you need to do in order to meet all eligibility requirements before wasting any time on doing things that won’t make any difference at all – and to avoid simply waiting for a response due to not knowing what else you’re required to do.
Source: healthinsurancequotes.me

The complete guide to the best of insurance companies: Compare

Compare-Medicare-Quotes.com fills the needs of consumers by offering health insurance plans with a wide variety benefits, coverages, and premiums in order to meet the growing needs of individuals. Compare-Medicare-Quotes.com’s state-of-the-art technology integrates with the quoting system of local agents who have the expertise to truly help consumers find the best health plan for their budget. So visitors to our site get complete details and comparisons about dozens of plan options that are open to them and they also get expert advice on which plans are most suitable to them.
Source: blogspot.com

How and Where Do I Get Medicare Insurance Quotes?

Not all insurance agents can provide this type of insurance. For example, do not call your friend who sells car insurance, he will not be licensed to sell Medicare insurance. When you find an agent who specializes in this area, ask for an appointment to set down with him so he can explain how all the plans work. You may want to add a prescription plan if you take a lot of medications. Your agent can help you deicide and he will give you Medicare insurance quotes for you to consider. This can be done anytime of the year, but in the fall is time for open enrollment and you may be able to save some money by getting your Medicare insurance quote during this time period.
Source: seniorcorps.org

The anniversary of Medicare

I, for one, can’t wait for universal health care. Most industrialized countries implemented it after the war and have far lower health care costs and for better coverage because of it. But for some reason the United States has been resisting it all along, even though it’s the only thing that makes logical sense. Create a pool that covers everyone so premiums for all are as low as humanly possible. Everyone shares, everyone benefits, and no one is left out in the street to die or has a medical bill so crushing that they have to declare bankruptcy after losing all their assets.
Source: minnpost.com

Elizabeth City District, United Methodist Church: ecdistrict.nccumc@blogger.com

Welcome to the blog (short for “Web Log”) for the Elizabeth City District of the United Methodist Church. This blog is an attempt to make our web presence more useful and interactive. We welcome lay and clergy members of the Elizabeth City District to contribute and comment on the contents here. As needs arise, we will be posting important and useful files that you can download to your computer. Please check back here regularly.
Source: blogspot.com

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