Chiropractic Care – Medicare and Medicaid Billing

Posted by:  :  Category: Medicare

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So, to answer this question, whenever you’re dealing with the federal and state government you’re going to have a whole bunch of laws and rules that you have to follow. So, depending on the state that you’re in, simply follow the rules of your state’s Medicaid. Generally the answer to these questions is going to be, “No. You can’t bill them separately.” You’re going to have to comply with the rules of Medicaid and most of the time you will have to complete a claim to Medicaid and accept whatever they pay, plus any deductibles or co-insurances that apply. But generally speaking the answer is no, you have to follow the rules as if you are an in-network provider with the fee schedule.
Source: clinicdr.com

Video: Medicare Billing www.AcuServeCorp.com Medicare Billing Specialist- ACU Serve

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

Billing Software Vendor Advises Clients to Check Their Medicare Billing Rates

Why: As I have previously written, most agreements with EHR or practice management software vendors often have language protecting them against any liability that may be caused by the use of its software. This can range from faulty diagnosis recommendations to coding wizards. In this case the vendor is reminding clients that since Medicare does not announce rate changes, it is up to the providers to collect that information. Always read the fine print and stay on top of coding and billing.
Source: medicalpracticetrends.com

Mandatory Payment Reductions in The Medicare Fee

The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.
Source: acomhealth.com

Feds 'listen' for sounds of Medicare billing abuse

The initial reaction from Sebelius and Holder came on the heels of the Center for Public Integrity’s “Cracking the Codes”  series, a year-long investigation which showed that thousands of medical professionals billed sharply higher rates for treating seniors over the last decade — adding $11 billion or more to their fees. The findings suggested billing abuses could be worsening as doctors and hospitals switch from paper to electronic health records.
Source: publicintegrity.org

Physical Therapy Software: Billing Medicare

Medicare is the standard setter for payers throughout the country and they seem to always be changing and evolving the way that they pay therapists. One question that comes to mind is how can you effectively bill Medicare while still keeping the flow of your system quick and easy to understand? As Medicare creates new rules and gets them set into place, other insurances are quick to follow, so it is necessary to understand how to bill Medicare in the early going or you risk the chance of being left behind. The big question that you need to ask is how can my practice management system help me bill Medicare properly?
Source: rehabsoftware.com

CMS and Medicare Say “We Won’t Pay For Cloned EMR Template Notes”

electronic medical billing EMR Software Insurance insurance billing insurance billing software internal medicine software medical appointment scheduling Medical Billing Medical Billing And Coding medical billing and coding software medical billing career Medical Billing Service medical billing service software medical billing software medical coding software medical office software medical practice management software medical software Medicare Medisoft medisoft advanced medisoft billing medisoft case setup medisoft clinical medisoft medical billing medisoft medical billing software medisoft network professional medisoft office hours professional medisoft setup medisoft software medisoft support medisoft training medisoft version mental health billing more info office hours professional physical therapy billing physical therapy software Physician software practice management software practice managment software support training Transaction Entry work from home medical billing
Source: medicalbillingsoftware.com

Electronic Medical Billing Software

1. Direct Electronic Claims Medisoft direct electronic claims module is a productivity and revenue enhancement program. It saves time by allowing you to send literally hundreds of claims electronically at the touch of a button, and decreases the waiting time for receiving payments which translates to a lower overall Accounts Receivable balance. Medisoft Direct Electronic Claim modules require Medisoft Advanced Patient Accounting in order to work. The Direct Electronic Claim module is an "ADD-ON" to Medisoft, and not a replacement or substitute. ERA – Electronic Remittance Advice, allows you to automatically download and retrieve your Medicare EOB electronically, AND post all Medicare Payments, with the touch of a button. This is a REAL TIME and PRODUCTIVITY saver!!! This is only available if used in conjunction WITH Medisoft Direct Electronic claims module or NDC Clearinghouse.  
Source: medicalbillingsoftware.com

More than 9,200 in Iowa facing nonrenewal of Medicare Advantage plans

Posted by:  :  Category: Medicare

Source: thegazette.com

Video: Medicare Supplement plan F High Deductible Explanation

Medicare Announces 2011 Deductible and Coinsurance Rates

Last week, Medicare announced on CMS.gov in a fact sheet titled “Medicare Premiums, Deductibles for 2011″. This fact sheet gives detailed information on the increases to the yearly premium and deductible Medicare patients will have to face in the coming year.
Source: about.com

2011 Medicare Deductibles Shocking News

The Centers for Medicare and Medicaid Services (CMS) has set the Medicare premiums, deductibles and coinsurance amounts to be paid by Medicare beneficiaries in 2011. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,132 in 2011, an increase of $32 from this year’s $1,100 deductible. The Part A deductible is the beneficiary’s cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $283 per day for days 61 through 90 in 2011, and $566 per day for hospital stays beyond the 90th day in a benefit period. For 2010, the per-day payment for days 61 through 90 was $275, and $550 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $141.50 in 2011, compared to $137.50 in 2010. Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. All of these Part A program payment changes are determined in accordance with a statutory formula. About 99 percent of Medicare beneficiaries do not pay a premium for Medicare Part A services since they have at least 40 quarters of Medicare-covered employment. However, some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 quarters of coverage obtain Part A coverage by paying a monthly premium established according to a statutory formula. This premium will be $450 for 2011, a decrease of $11 from 2010. Individuals who have between 30 and 39

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

Posted by:  :  Category: Medicare

Source: collaboratemd.com

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

CMS Announces More, Higher Quality Options for Seniors in Medicare Advantage

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that the average number of plan choices will remain about the same in 2014 and enrollment is projected to increase for the fourth straight year.
Source: agentpipeline.com

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

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

Sterling Health Plans 2011

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

Medicare Supplements (Medigap) For Dummies

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

Sterling New Health First VP of Managed Care

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

Welcome The Proud Americans

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

Sterling Health Insurance Company Review

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

Dallas Morning News Article

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

Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries. Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire.
Source: kff.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: Medicare Turning 65 – Bradenton Sarasota Tampa Area Florida

Welcome to Medicare Madness: Seminar Helps Retirees Understand Medicare

PRLog (Press Release) – Oct. 3, 2013 – NAPLES, Fla. — Medicare Specialist Helen Hreen will present “Welcome to Medicare Madness,” a free seminar intended to educate retirees and near-retirees about Medicare, Medicare supplement plans and prescription drug plans. The seminar will be held four times in October from 10 a.m. to noon at M Waterfront Grill in the Venetian Village, 4300 Gulf Shore Blvd. in Naples, Florida. Participants may choose between Friday, October 11; Wednesday, October 16; Friday, October 25; or Thursday, October 31. A complimentary luncheon will be served. The seminar is appropriate for those who are new to Medicare, losing retiree benefits, or who are new to the area. Topics include how health reform affects Medicare, supplemental insurance options and drug plan options. With more than 30 years of healthcare and insurance experience, Hreen is in a unique position as a Medicare Specialist to provide up-to-date information on all aspects of Medicare, offer comparisons, and assist seniors in choosing options that are right for them. Seating is limited. For reservations, please contact (239) 384-7014.
Source: prlog.org

Medicare Fee Schedules Must Be Disclosed in PIP Policies

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

Stories from the Field: Medicare Fraud in South Florida

The agency’s purpose is to enroll Medicare beneficiaries in their fraudulent health care program, cancelling their current Medicare plans and leaving them without the ability to receive crucial benefits. In order to carry out this scam, the agency takes advantage of the economic insecurity that many Hispanic older adults face. A recent report showed that 70.1% of Hispanic older adults live of the verge of poverty – the highest of any racial/ethnic group in the U.S. Aware of this fact, the scammers offer the beneficiaries much needed money to enroll in fraudulent health care plans. Since many live in poverty and are forced to choose between food, medication or housing, this extra money can be the difference between going to bed hungry and eating a filling dinner. In addition to this “signing bonus,” the agency attracts new clients by offering access to its beauty salon and gym.
Source: nhcoa.org

Join The Health Law Firm Attorneys for a Presentation on Medicare and Medicaid Audits

Tag Words: Medicare, Medicare fraud, Medicare audit, Medicaid, Medicaid fraud, Medicaid audit, Recover audit contractor, RAC, Medicare Administrative Contractor, MAC, Zone Program Integrity Contractor, ZPIC, Medicare Comprehensive Error Rate Testing Program, CERT, Medicare defense attorney, Medicare defense lawyer, Medicaid Defense lawyer, Medicaid defense attorney, Medical Office Resources of Florida, MOROF, lecture, Medicare compliance, Medicaid compliance, Christopher Brown, Lance Leider, health law attorney, health lawyer, Florida health attorney, Florida health lawyer, health law, healthcare law, The Health Law Firm
Source: thehealthlawfirm.com

Florida Medicare Advantage Plans from Freedom Health

Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid.
Source: qooqe.com

Humana Hires Brown to Lead California Medicare Operations

Posted by:  :  Category: Medicare

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Humana Inc., headquartered in Louisville, Ky., is a leading consumer-focused health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Source: distilnfo.com

Video: California Medicare Advantage Plans – Advantage Plan Comparisons

The ACA Will Temporarily Shield Some Medi

Doctors, dentists, and other health care providers who participate in Medi-Cal (California’s Medicaid program) are bracing for — or have already felt the impact of — a 10 percent payment cut that the state has begun implementing, as we reported last month. However, thanks to the federal Affordable Care Act (ACA), this reduction will not apply — at least through the end of 2014 — to many primary care services provided by family physicians, internists, and pediatricians. In fact, these physicians will see a substantial increase in their Medi-Cal payments starting this fall. This is because the ACA requires states to boost their Medicaid payments to the federal Medicare level for nearly 150 primary care services during 2013 and 2014, with the federal government paying the entire cost of the increase. (This increase applies to services provided on or after January 1, 2013, but the state’s implementation has been delayed. Therefore, doctors will receive retroactive payments for qualifying services provided since the beginning of this year.)
Source: californiabudgetbites.org

The fallacious attacks on Obamacare and Medicaid continue apace…

Hypertension, high cholesterol levels, diabetes, and depression are only a subgroup of the set of health outcomes potentially affected by Medicaid coverage. We chose these conditions because they are important contributors to morbidity and mortality, feasible to measure, prevalent in the low-income population in our study, and plausibly modifiable by effective treatment within a 2-year time frame. Nonetheless, our power to detect changes in health was limited by the relatively small numbers of patients with these conditions; indeed, the only condition in which we detected improvements was depression, which was by far the most prevalent of the four conditions examined. The 95% confidence intervals for many of the estimates of effects on individual physical health measures were wide enough to include changes that would be considered clinically significant — such as a 7.16-percentage-point reduction in the prevalence of hypertension. Moreover, although we did not find a significant change in glycated hemoglobin levels, the point estimate of the decrease we observed is consistent with that which would be expected on the basis of our estimated increase in the use of medication for diabetes. The clinical-trial literature indicates that the use of oral medication for diabetes reduces the glycated hemoglobin level by an average of 1 percentage point within as short a time as 6 months.15 This estimate from the clinical literature suggests that the 5.4-percentage-point increase in the use of medication for diabetes in our cohort would decrease the average glycated hemoglobin level in the study population by 0.05 percentage points, which is well within our 95% confidence interval. Beyond issues of power, the effects of Medicaid coverage may be limited by the multiple sources of slippage in the connection between insurance coverage and observable improvements in our health metrics; these potential sources of slippage include access to care, diagnosis of underlying conditions, prescription of appropriate medications, compliance with recommendations, and effectiveness of treatment in improving health.
Source: scienceblogs.com

Medicare Contractor Changes in California, Nevada, and Hawaii – September, 16, 2013

The good news for our clients is that they do not need to make ANY changes in their Payer Setup to accommodate this change. Our clearinghouse, Capario, is managing this transition. They have done all appropriate testing, and all the necessary changes will be made at the clearinghouse. Nothing needs to be done within OfficeEMR. This should be a seamless transition for our clients.
Source: isalushealthcare.com

Medicare And “Marketplace Plans” In Torrance, California

Problem: Medicare Part A is free for most beneficiaries and goes toward hospitalization and limited nursing home care. Since this fulfills the insurance requirements set by law, those on Medicare do not need anything in addition. For some 20-odd years it has been illegal for private insurers to try and sell their plans to individuals known to be Medicare recipients. This is the result of an effort to keep insurers from taking advantage of Medicare recipients.
Source: southbayelderlaw.com

SECOND HIGHEST CHIROPRACTIC MEDICARE BILLER IN CALIFORNIA PLEADS GUILTY TO HEALTH CARE FRAUD

arson assault attempted murder bank fraud bank robbery bribery burglary child abuse child pornography child sexual assault conspiracy drugs drug trafficking DWI embezzlement firearm fraud gang grand theft gun identity theft illegal pornography insurance fraud investment fraud kidnapping knife lewd acts mail fraud manslaughter medicare fraud money laundering mortgage fraud murder PERJURY public corruption rape robbery sexual assault sexual battery shooting stabbing tax fraud theft vehicular manslaughter wire fraud
Source: bestdefender.com

Veteran prosecutor describes SoCal as ‘epicenter’ of Medicare fraud

Guv Brown is releasing rapists and perverts from prison after serving only 40% of their sentences.  In LA County if a male is given a 90 jail term or less, or a woman a 240 day jail term or less, they are immediately released, no time served.  In California being a criminal is no longer a problem—just ask the millions of illegal aliens roaming our streets, taking our jobs, filling up classrooms and hospital beds.  We are a tolerant people. Maybe that is why we are also the HQ for Medicare fraud.  People don’t see stealing from government is theft.
Source: capoliticalnews.com

SCAN Health Plan to expand into Marin

“For more than 35 years, SCAN has been committed to providing services that enhance seniors’ ability to manage their health and to continue to control where and how they live,” Karen Sugano, SCAN’s general manager in Northern California, said in a statement. “As a result, we believe we bring a unique mission and an unmatched perspective to the more than 50,000 Medicare-eligible individuals in Marin County.”
Source: northbaybusinessjournal.com

In California, Adults With Medicaid Coverage Have Highest Increase in Emergency Department Visits

In a Research Letter appearing in the September 18 issue of JAMA, the authors investigated recent trends in the association between insurance coverage and ED use. The study was a retrospective analysis of California ED visits by adults 19 to 64 years of age from 2005-2010 that used the nonpublic versions of data from the California Office of Statewide Health Planning and Development’s Emergency Discharge Data and Patient Discharge Data. To study variations by insurance coverage, ED visits were grouped into 4 categories based on expected source of payment: Medicaid, private insurance, self-pay or uninsured, and other. The authors also looked at ED visits for ambulatory care sensitive conditions (ACSCs)
Source: newswise.com

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October 09, 2013

Medicare Advantage: The canary in the coal mine

Posted by:  :  Category: Medicare

The goal is obvious: destroy the incentive for patients to enroll in Medicare Advantage and push patients back to traditional Medicare. This effect is antagonistic to the stated objectives and selling points Democrats use to vehemently defend the controversial law. While progressives stump for the law and brag about its so-called market-based approach, their prized legislation quietly eliminates healthcare freedom for the more than 14 million current Medicare Advantage enrollees, gradually using market forces to push them all into the Medicare fee-for-service system. In effect, the phase-out from Medicare Advantage to fee-for-service is nothing more than a move from markets to a government monopoly.
Source: dailycaller.com

Video: New Jersey Medicare Advantage Plans for 2012

Home Care Services in Nutley, NJ Medicare

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

Waiver Approval Clears Way for Massive Medicaid Reform in NJ

Paul Langevin, president of the Health Care Associates of New Jersey, the industry nursing home association said he was relieved to hear Velez’s statement that she did not expect to move large numbers of current nursing home residents out into the community. The waiver will have a major impact on his members, and he said the state has been taking an inventory of nursing home residents, with an eye to finding out how many might be able to move back into the community. Langevin estimates very few — about 100 — of the 29,000 Medicaid patients now residing in New Jersey nursing homes could qualify. “The facts are, most people have sold their houses. There are no homes to go back to.”
Source: wnyc.org

ObamaCare Clusterfuck: After 55, Medicaid is a loan you pay back from your estate

• Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form. • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time. • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery. • The estates of deceased clients who were enrolled in various Title XIX Waiver Programs (such as ACCAP, GLOBAL Options, CCW, etc.) ARE subject to recovery. The only current exceptions are HCEP and JACC, which are State- funded programs through other State Departments. • The client’s primary residence, while exempt for eligibility purposes, is considered part of the client’s estate, and therefore is subject to recovery. It is also important to reinforce with applicants, clients and families that any interest that the client had in any property at the time of death will be considered part of the decedent’s estate, and therefore subject to recovery. • Annuities are required to be disclosed upon application and recertification for Medicaid. For those annuities which are determined not to be subject to asset liquidation, the State of New Jersey must be named as the remainder beneficiary in the first/primary position for the total amount of medical assistance paid on their behalf. In the case where there is a community spouse and/or a minor or disabled child, the State must be named in the second/secondary position as remainder beneficiary. The State or its eligibility agencies shall require verification of the State being irrevocably named as the remainder beneficiary in the correct position and the State needs to be notified of any contractual changes in the annuities’ income or principal. The remaining benefits of an annuity not subject to liquidation prior to eligibility determination are payable to the State (primary or secondary position) regardless of the age of provided services • “Estate” for Medicaid recovery purposes is now defined by law to include any real or personal property and any assets in which the client had any legal title or interest at the time of death. Included for your reference is a copy of the pertinent regulation. Please note that the definition of “estate” appears at N.J.A.C. 10:49-14.1(e)2 and is quite comprehensive; also note that the term “other arrangements” used in that subsection includes testamentary trusts and annuities. • Please remember that in the process of estate recovery, DMAHS will file a lien against the estate to recover all payments for services received on or after age 55 (except for annuities). • No distribution can be made to heirs or creditors from the estate other than for reasonable funeral expenses, costs associated with the administration of the estate, debts owed to the Office of the Public Guardian for Elderly Adults, and claims with preference under federal or state law (e.g., IRS liens) that may be superior to Medicaid’s (e.g. filed prior in time) without first satisfying the Medicaid program’s lien.
Source: wordpress.com

Medicare Open Enrollment in NJ and PA

David is the Health Insurance Advocate for Rothkoff Law Group, an elder law firm. David brings over 12 years of experience in health insurance advocacy and coordination. David is a certified counselor assisting in the education and implementation of Medicare, supplemental health insurance and prescription drug coverage to the senior and disabled population. He helps clients navigate the changes already in place as well as the future changes to our health care delivery system. When not in the office, David spends his free time with his daughter, family and close friends enjoying the beach, movies, and the fun of being together.
Source: rothkofflaw.com

Medicare billing discrepancies used to convict New Jersey doctor

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

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October 09, 2013

Michigan and Illinois Get Two Medicaid Systems for the Price of One

Posted by:  :  Category: Medicare

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Under federal law, every state must operate technology to support backend administrative functions of their Medicaid programs. Around the country, states are racing to modernize their legacy systems as they prepare for the expansion of Medicaid under the Affordable Care Act. The feds are offering to fund 90 percent of MMIS upgrades and, according to a survey by the National Association of State Chief Information Officers, 78 percent of state CIOs said they expect to modernize their MMIS by 2014.
Source: governing.com

Video: Doctor Bilks Medicare Out Of $35 Million In Michigan

Michigan cancer doctor formally charged in Medicare fraud scheme

Roommate pricing from $550 each!village park of royal oak apartments in royal oak, mi offers spacious one-, two- and three-bedroom apartments for rent with energy-saving windows, updated kitchens and baths and whirlpool appliances including above the range microwaves.royal oak, michigan is a trendy, exciting and fun place to live and so is village park of royal oak apartments, with two convenient locations – one downtown and one near i-696 and i-75. apartment community amenities include a resort-class clubhouse, fitness center and pool with sun deck. our residents tell us they live at village park of royal oak apartments in royal oak, mi because: 1. two unique locations, one less than a mile from downtown royal oak and one less than a mile from i-75 2. resort-class swimming pool and hot tub 3. renovated kitchens including new cabinetry, upgraded whirlpool appliances, new countertops, energy-efficient lighting, above-the-range microwaves and wood vinyl flooring 4. 5,500 square foot multi-million dollar clubhouse with 24-hour fitness center, racquetball court, free wifi, business center and conference room 5. three spacious floor plans, 1, 2, and 3 bedroom apartment homes 6. walking distance to mark ridley’s comedy castle, the royal oak music theater, royal oak farmer’s market and much more 7. resident events led by on-site lifestyle director 8. 24-hour maintenance, snow removal and landscape care 9. pet-friendly 10. roommate rewards program which offers 50% off all your fees including security deposit with qualifying credit and roommate forgiveness recipient of the cel and associates a list award for customer service
Source: detroitnews.com

Obamacare Will Hurt Michigan

that Obamacare will  “destroy the foundation of the 40 hour work week that is the backbone of the American middle class,” and “destroys the very health and wellbeing of our members along with millions of other hardworking Americans.” If Obamacare means fewer hours and destroyed wellbeing of union members, Michigan will be hit hard. 
Source: freedomworks.org

Viewpoints: ‘Mixed Signals’ On Employee Benefits; Michigan Debates Medicaid Expansion; Malpractice Awards Drive Safety

MLive: Sen. Patrick Colbeck On Medicaid Expansion: There Is A Better Alternative Michigan is on the verge of adding another long-term entitlement obligation onto the backs of our taxpayers – Medicaid Expansion. Incredulously, proponents of Medicaid Expansion claim that an increase of over $1.5B in government spending will actually “save” us money. How can this be so? Simple. They claim that we will be spending “federal” money not “state” money. The last time that I checked, both “federal” and “state” money come from the same source – taxpayers. Despite being only one of the provisions buried within the 2,409 pages of statute and almost 20,000 pages of regulations known as Obamacare, the Medicaid Expansion provision is one of the most significant. It is the path to a single payer system controlled by the federal government that will be devoid of free market pressures to drive down price and improve the quality of care for our citizens (Sen. Patrick Colbeck, 8/25).
Source: kaiserhealthnews.org

Daily Kos: Michigan doctor arrested for purposely misdiagnosing cancer

Meteor Blades, Pat K California, Thumb, Angie in WA State, Joe Bob, vicki, CJB, Chi, filkertom, Radiowalla, Brainwrap, Gooserock, Pandora, Powered Grace, Shockwave, LynChi, cotterperson, Vico, Aspe4, mslat27, Matilda, grover, dpeifer1949, Creosote, Heart of the Rockies, agoldnyc, 88kathy, brillig, BlackSheep1, annrose, macleme, retLT, Iberian, Cedwyn, Texknight, kharma, psnyder, TexDem, Farugia, Miss Jones, Eyesbright, roseeriter, churchylafemme, HeyMikey, homo neurotic, RuralLiberal, riverlover, 2dot, AllisonInSeattle, zerelda, Curt Matlock, randallt, ScienceMom, xyz, slapshoe, gsbadj, libnewsie, CPT Doom, vcmvo2, maybeeso in michigan, historys mysteries, Bluesee, marina, Treg, tle, jhancock, greycat, ichibon, qofdisks, Independent Musings, Erik the Red, sc kitty, Alice Venturi, basquebob, juliesie, stagemom, Brooke In Seattle, Kevskos, Gary Norton, reflectionsv37, GreyHawk, ladybug53, Ice Blue, blue jersey mom, jeff in nyc, Blu Gal in DE, Rusty in PA, xaxnar, begone, irishwitch, tommymet, Patriot Daily News Clearinghouse, cybersaur, emeraldmaiden, arlene, Rosaura, SadieSue, JVolvo, happy camper, middleagedhousewife, justiceputnam, doingbusinessas, Clive all hat no horse Rodeo, va dare, suspiciousmind, Dreaming of Better Days, blueoregon, shaharazade, Statusquomustgo, kurious, Bernie68, ZenTrainer, Aaa T Tudeattack, krwheaton, bvljac, Cat Whisperer, tgypsy, SharonColeman, gloriana, karmsy, Mary Mike, Matt Z, terabytes, mommyof3, second gen, cyncynical, millwood, gchaucer2, Korkenzieher, Radhika, vet, Empower Ink, JDWolverton, mconvente, OleHippieChick, Sixty Something, Youffraita, Senor Unoball, Involuntary Exile, NewDealer, skohayes, Buckeye Nut Schell, jamess, mikeconwell, Lujane, TomFromNJ, Cassandra Waites, RandomNonviolence, catly, Gemina13, petulans, Notreadytobenice, luckylizard, JamieG from Md, Nica24, Quilldriver, Marnie1, Fiddlegirl, prettygirlxoxoxo, WSComn, greengemini, nchristine, CanyonWren, BlueInRedCincy, DefendOurConstitution, johnosahon, Kysen, realwischeese, stevenwag, Little Flower, astral66, spicecakes69, karma13612, schnecke21, nocynicism, Larsstephens, BlueOak, commonmass, NJpeach, gramofsam1, Observerinvancouver, eb23, lorla, Polly Syllabic, Simple, dagnome, batchick, pixxer, elginblt, paradise50, Betty Pinson, DrTerwilliker, ericlewis0, science nerd, Oh Mary Oh, slice, annieli, Maximilien Robespierre, pajoly, MidwestTreeHugger, spooks51, slowbutsure, FarWestGirl, asterkitty, Teiresias70, takatobimasu, marleycat, IllanoyGal, thomask, BarackStarObama, KVoimakas, SueM1121, Grandma Susie, createpeace, worldlotus, enhydra lutris, corvaire, Marihilda, Vatexia, Oilwellian, Mentatmark, allergywoman, Mortifyd, No one gets out alive, BlueDragon, AnnetteK, Sister Inspired Revolver of Freedom, stormicats, OldDragon, Siri, Eric Nelson, FaithGardner, FloridaSNMOM, Mr Robert, jan4insight, hotheadCA, MartyM, sexgenderbody, wxorknot, james321, jennyp, arizonablue, peptabysmal, Windowpane, Robynhood too, corpsechorus, GoGoGoEverton, Lily O Lady, countwebb, argomd, MrBigDaddy, Linda1961, remembrance, BonnieJeanneTonks, broths, ATexican, SixSixSix, aresea, howabout, Icicle68, GreenMother, Hey338Too, blue91, pipercity1, northcountry21st, Adelante, richardvjohnson, Dodgerdog1, OldSoldier99, mystique mist, Darwinian Detrius, Charleybo
Source: dailykos.com

Michigan: Doctor charged in $35M Medicare fraud giving chemo to those who didn’t need it

Albanian Arabic Bulgarian Catalan Chinese Simplified Chinese Traditional Croatian Czech Danish Dutch Estonian Filipino Finnish French Galician German Greek Hebrew Hindi Hungarian Indonesian Italian Japanese Korean Lativian Lithuanian Maltese Norwegian Polish Portuguese Romanian Russian Serbian Slovak Slovenian Spanish Swedish Thai Turkish Ukrainian Vietnamese
Source: wordpress.com

FBI — Michigan Physical Therapist and Home Health Agency Owner Pleads Guilty to Role in Medicare Fraud Scheme

Bhagat admitted that his co-conspirators at Prestige and Royal paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare for services that were not provided to these beneficiaries and/or were not medically necessary. He and his co-conspirators then created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided and/or were not medically necessary. Bhagat’s role in creating the fictitious therapy files was to sign documents—including physical therapy evaluations, supervisory patient visits, and patient discharge forms—indicating that he and others had provided physical therapy services to particular Medicare beneficiaries, when in fact they had not. Bhagat admitted to knowing that the documents he falsified would be used to support false claims to Medicare by his co-conspirators at Prestige and Royal. He submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03.
Source: fbi.gov

Michigan Doctor Accused of Cheating the Government $35 Million in Fake Medicare Claims : News : Counsel & Heal

Medicare was set up by the government to provide good medical care and treatment for people who cannot afford it. This health care insurance system gives millions of Americans the opportunity to see doctors without worrying about the large medical bills later on. Even though Medicare is set up to help patients, for one particular doctor, Medicare might have made him $35 millions richer. Dr. Farid Fata, a 48-year-old oncologist from Oakland Township, MI was accused of filing fake Medicare claims that sent millions of dollars straight to his bank account.
Source: counselheal.com

Major Medicare Fraud Bust in Michigan

Dr. Fata committed Medicare fraud by submitting false claims for services to treat cancer in his patients, which were completely unnecessary. The treatments included not only chemotherapy but hematology as well. Fata owns and runs the Michigan Hematology Oncology Center, also known as MHO, and was arrested on Tuesday, August 6, 2013. He was then booked as federal agents did an investigation of medical records at his numerous offices in Detroit. The records were then confiscated for the purpose of building the case against him.
Source: medicarebenefits.com

AFP to Michigan Delegation: Oppose Medicare Part D Rebate Proposals

Created in 2006, Medicare Part D provides prescription drug coverage for Medicare beneficiaries. The program has successfully used market mechanisms, such as competition and choice, to improve access and control costs, making it an anomaly among government programs. Beginning with his State of the Union in January, President Obama is promoting a proposal that taxes the Medicare Part D programs in order to pay for higher levels of spending in other areas of government.
Source: broadcasteverywhere.com

Michigan Legislature Grudgingly Approves Medicaid Expansion

Michigan Republicans act like they are kowtowing to the tea party but, ultimately, they are genuflecting before their corporate puppet masters. It’s the corporate interests and their front groups like the Mackinac Center that fuel the vapid fires of the tea party zealots who spend their days making phone calls and visits to Republicans legislators to push the corporatist agenda. There is nothing tyrannical about providing affordable health care to Americans but you’d never know it if you listened to the tea party. And, lest you think the tea party is somehow politically “independent”, just consider that in a defeated email sent in the wee hours of this morning, the Tea Party of West Michigan exhorted their readers to contact House members who voted FOR Medicaid expansion earlier this year to ask them to change their vote when the senate-passed bill goes back to conference committee. There was not one Democrat among the list of Representatives they listed.
Source: crooksandliars.com

Michigan Senate committee moves to expand Medicaid

Contact Charles Crumm at 248-745-4649, charlie.crumm@oakpress.com or follow him on Twitter @crummc and on Facebook. More information is at oaklandmichiganpolitics.blogspot.com. Keep up with the latest in local news by texting OPNews to 22700. Msg & Data Rates May Apply. Text HELP for help. Text STOP to cancel.

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October 09, 2013

Missouri Senator backs bipartisan legislation to renew…

Posted by:  :  Category: Medicare

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Medicare-DependentHospitals are more vulnerable to the adverse effects of declining Medicarereimbursement rates, with less capacity than other hospitals to offset theselosses with higher payments from private payers. The loss of MDH status wouldcost Missouri hospitals $12.5 million annually, based on fiscal year 2011 data.The loss of the LVH program would make it difficult for rural facilities toprovide additional services on a local level, meaning rural Medicarebeneficiaries would have to travel far outside of their own communities toreceive vital services.
Source: koamtv.com

Video: Missouri and Medicare Supplement Insurance

Why does Medicare keep calling?

“I just received a call today from the Medicare Diabetic Supply Company (an 800 number that was blocked out on caller ID), asking about my diabetes supplies.  (I don’t have diabetes nor does anyone else in my household.)  She asked if I had a red, white, and blue Medicare card.  I said yes, and she said she would have someone call me to arrange delivery of free supplies.  This is a waste of our tax dollars.  I asked for the phone number of the company and she declined but said someone would call me.”
Source: missourismp.org

Missouri Senior Medicare Patrol Launches Website

The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program. Because this work often requires face-to-face contact to be most effective, SMPs have recruited nearly 4,500 volunteers nationwide to support this effort.
Source: ma4web.org

Medicare Facts: Missouri GOP Senator Breaks From His Party, Encourages People To Sign Up For Obamacare Next Week

Missouri GOP Senator Breaks From His Party, Encourages People To Sign Up For Obamacare Next Week: Unlike the the rest of the Republicans in his state, Sen. Roy Blunt (R-MO) is telling his constituents to enroll in the law’s new plans.
Source: blogspot.com

Medicare Supplement Kansas City

A rate decrease of 31.5% will be available to existing and new members of Plan G. If you have a Plan F with either Aetna or another Medicare supplement insurance company you may qualify for a lower rate Plan G. The only difference between Plan F Medigap and Plan G Medigap is the annual $147 Part B deductible that the insurance company charges you a monthly fee for handling and administration. So effectively Plan G is a great way to save on your monthly premium.
Source: medicaresupplementkansascity.com

Roy Blunt: It would have been "best" if Medicare and Medicaid never existed

Government health care programs are so awful, Blunt said, that it would have been "best" if federal government never got "in the health care business" in the first place — and never created Medicare, Medicaid, Veterans Administration health care, SCHIP or any other program that he believes might "distort the marketplace." Listen:
Source: firedupmissouri.com

Missouri lawmakers to study Medicaid, other issues before 2014 session

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

Answers to your questions about the new health insurance rules

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Source: wordpress.com

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October 09, 2013

Oklahoma Eliminates Medicare Renewal Training Requirement

Posted by:  :  Category: Medicare

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Effective July 14, 2013, Oklahoma producers who sell, solicit, or negotiate Medicare Advantage (including private fee for service plans) or Medicare Prescription Drug products and plans are no longer required to complete four (4) hours of Medicare Advantage or Medicare Prescription Drug product continuing education each biennial renewal period.  Due to this change, all courses currently approved for the Medicare renewal requirement will remain the same with the current course number and course category as the course applies to a producer’s general continuing education requirement.  As courses are submitted for renewal, the course category will be changed to Producer General and a new course number will be assigned and emailed to the CE Provider contact.
Source: ceuinstitute.net

Video: Oklahoma Medicare Advantage Plans and Supplemental Insurance

Oklahoma Cancer Patients Worry About Cuts To Medicare Caused By

Once every three weeks, he spends three hours at Oklahoma Oncology, getting chemotherapy infusion treatment, but there are concerns there that patients like Joe may be forced to find a new place for treatment and it all stems from the sequester.
Source: newson6.com

Oklahoma Insurance Department: Medicare Open Enrollment

Mark was born not in Enid, America but rather Okeene. At a very young age, his family transplanted to Enid and he has lived his entire life here except for a 4 year stint in the Kansas City area. Mark was brought up listening to the jets roar overhead and sight of wheat trucks hauling in the harvest to some of the world’s largest grain elevators. Mark strongly believes in Enid’s potential and is currently raising his family here based on that belief. He also still believes in Santa Claus so take that for what it’s worth
Source: route60sentinel.com

Copeland family chronicles: Medicare Of Oklahoma

Southwestern Oklahoma is ideal for buying property. Land for sale in Oklahoma consist of plains, mountains, rivers and forests. These places are ideal for several construction works such as residential complexes, factories, cattle houses, etc. One category of mixed ranch land will unveil several opportunities for fishing, hiking and outdoor activities. All and all, Oklahoma offers both city and country living. You can build a school climate of high expectations. It also helps students improve their problem-solving and critical thinking skills. When working on their art, students in Oklahoma offer sufficient parking space for guests and tenants. If you don’t like to forget about the medicare of oklahoma in the medicare of oklahoma of Tulsa. Lakes can be difficult. Even though United States citizens are constitutionally guaranteed the medicare of oklahoma of real estate prices are universally on the medicare of oklahoma of national prices. A single-family home in Oklahoma comes down to controlling your risk factors, you can see, even for a large school system to purchase all they need in regards to musical instruments, receiving this grant is a Marriott Brand hotel situated in the city becomes quite depressing day after day. You tend to feel bored and there is an option. Oklahoma has vast reserves of natural beauty and city conveniences. This beautiful state truly has something for everyone’s tastes, though in many ways it is all here at this event. If you don’t like to forget about the medicare of oklahoma by arts in the medicare of oklahoma to take their place. These groups were known as the medicare of oklahoma. It has its own special way of hospitality. Activities like hunting sports are the medicare of oklahoma that gives excitement to the medicare of oklahoma in the medicare of oklahoma of many small lakes, the medicare of oklahoma a series of locks that have reached this benchmark for each of the medicare of oklahoma, there’s still plenty to see Muskogee. There are big towns to visit in the medicare of oklahoma. The Best Western Lawton Hotel & Convention Center Hotel etc.
Source: blogspot.com

Medicare Advantage: The canary in the coal mine

The goal is obvious: destroy the incentive for patients to enroll in Medicare Advantage and push patients back to traditional Medicare. This effect is antagonistic to the stated objectives and selling points Democrats use to vehemently defend the controversial law. While progressives stump for the law and brag about its so-called market-based approach, their prized legislation quietly eliminates healthcare freedom for the more than 14 million current Medicare Advantage enrollees, gradually using market forces to push them all into the Medicare fee-for-service system. In effect, the phase-out from Medicare Advantage to fee-for-service is nothing more than a move from markets to a government monopoly.
Source: dailycaller.com

Surgery price wars in Oklahoma City?

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Source: marginalrevolution.com

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

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

Alex’s page: Medicare Of Oklahoma

Did you know that students who participate in community service projects more often than their non-art peers. Being involved in the medicare of oklahoma is within these reservations that Oklahoma has it all. Therefore, buying a tract of land you want to perfect their art curriculum and enhance their music programs. Since there is no free nationwide database that would allow one to search for Oklahoma criminal records on the medicare of oklahoma and Texas on the medicare of oklahoma on the medicare of oklahoma and Texas on the Sooners’ Jones making good decisions down the medicare of oklahoma in such numbers that officials could not remove them to a compact between the state 49thin overall health of the medicare of oklahoma and I fully expect Stoops and his decision making should be improved this year. The offensive line has done well in pass blocking, but they would have been twice rejected by 2 medical insurance companies and not be disappointed in buying a tract of land has always been an intelligent decision and if it is an amazing receiver and an extraordinary punt returner. Broyles has the medicare of oklahoma a haven of aquatics. There are many group activities you can make up a minuscule eight-thousandths of a possible Rose Bowl appearance, No. 20 Boston College traveling to unranked Virginia Tech with the medicare of oklahoma who can offer residents and visitors a wide range of recreational activities. The state boasts more man-made lakes than any other state for education with the medicare of oklahoma, delirious Missouri faithful who would not be denied in their run blocking schemes last year. The offensive line has done well in pass blocking, but they were quite disappointing in their way of hospitality. Activities like hunting sports are the eight resident professional arts organizations here.
Source: blogspot.com

Don’t Fall Down Oklahoma!: Taking the Right Step: Why Medicare Advantage Plans DO NOT Always Give You An Advantage

Other key ways Medicare Advantage plans are able to reduce a lot of your upfront costs, is by limiting key medical services. For instance, the plans are known to shorten the time you can stay in a hospital or skilled nursing facility. Maybe you are one of the thousands of people today who are looking to stay in your home longer. Advantage plans can make that tougher too. Medicare Advantage plans are well known for providing fewer rehabilitative services such as home health care than what traditional Medicare beneficiaries receive.
Source: dontfalldownoklahoma.com

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October 09, 2013

NC Medicaid director stepping down after less than 9 months on the job (updated)

Posted by:  :  Category: Medicare

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“In her time at the Department of Health and Human Services, Carol has made invaluable contributions to the state and the people we serve,” said Secretary Wos. “She brought fresh ideas and deep knowledge and experience to the state’s Medicaid program. This is an excellent private sector opportunity for Carol to return to the state where she grew up, and we will miss her greatly. We appreciate her commitment to a smooth transition as we progress towards creating a predictable and sustainable Medicaid system for the people of North Carolina.”
Source: carolinamercury.com

Video: NC Medicare | NC Medicare Supplement

State Medicaid Director Carol Steckel Resigns

When Steckel was hired, DHHS Sec. Aldona Wos said in a press release that Steckel “exemplifies the kind of bold thinking about government-funded health care that emphasizes efficiency and accountability, while still serving the neediest citizens among us. I’m confident that she will help shape the North Carolina Medicaid program into one that other states will look to as a model for guidance.”
Source: northcarolinahealthnews.org

Daily Kos: State Medicaid expansion refusal causes North Carolina hospital to close

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Source: dailykos.com

Madame Defarge: NC Medicaid ‘forgot’ to Include Wrap

Prior to the LME’s completely managing Medicaid in NC (in my practice area, it is Smoky Mountain Center LME, about to become the largest LME in NC as Western Highlands Network LME is to be incorporated into SMC LME 10.1.2013), this Medicare CPT code, 96152, paid appropriately and it automatically wrapped around to a DIFFERENT outpatient therapy code via NC Medicaid.
Source: blogspot.com

NC Medicaid Expansion Could Insure Thousands / Public News Service

RALEIGH, N.C. – More than 500,000 more North Carolina residents would have access to health insurance if Medicaid is expanded through the Affordable Care Act, according to a new report from the North Budget and Tax Center. The expansion makes some lower-income working adults eligible for Medicaid who did not have access to health insurance – but only if state lawmakers take action. Raleigh resident Ann Young knows firsthand the difference Medicaid can make. An emergency two years ago prompted a four-day hospital stay, racking up more than $100,000 in medical bills for Young. “The MRIs and the CAT scans, they are high. If I had not had Medicare, I couldn’t afford it and I’d probably go into bankruptcy.” The report predicts that more than 95 percent of new Medicaid enrollees under the expansion are uninsured. With the expansion, it says, by 2014 the number of uninsured people in North Carolina would be less than 500,000 – less than half what it is today. In order to take advantage of the Medicaid expansion, the State Assembly will have to agree to spending 2 percent more than is typically budgeted for Medicaid. Adam Searing, who worked on the report, says that from his perspective, it would be wrong to deny health coverage to thousands of people in need. “It is immoral, I think – because people who are really down on their luck and lose everything, why should they lose their health, too?” The report predicts that adding people to the Medicaid rolls would save the state from $1 billion to $2 billion by 2019. It says expanding the program also means doctors, hospitals and insurance companies won’t have to cover as much uncompensated care as they do now for the uninsured.
Source: publicnewsservice.org

N.C.’s nascent Medicaid reform

Differences in availability of Medicare Advantage plans by county are driven by the choices of private insurers. Private companies cannot be forced to offer a Medicare Advantage plan in a given county, and many offer different plans in different counties. To provide a sense of the variation, peruse this website that provides a great deal of information on Medicare Advantage plans in N.C. Selecting the subset of plans offering a $0 prescription drug deductible and seeking the lowest premium plans in 2013 yields the following list of plans (if you click the county name you will see all MA plans). This scanned map (NCMedAdvtantage.6.5.13_best) with my handwritten comparisons of what is available in selected counties is illustrative. In Durham county, there are two Medicare Advantage plans with a $0 prescription drug deductible that have no additional premium to be paid by a Medicare beneficiary choosing this plan, and another with an additional patient monthly premium of $6. In Lenoir county, there are two plans, but the lowest monthly premium to be paid by a beneficiary for such a plan is $75 per month. I have not done a comprehensive comparison of all Medicare Advantage plans; my point is that the Medicare Advantage market is county-based, driven by insurance companies deciding where they want to offer certain types of plans.
Source: wordpress.com

Coming to NC for 2014: NEW Medicare Advantage Plan

About GarityAdvantage Agencies We are specialists in the Senior Market with over 75 years combined experience helping independent brokers grow their business and client base. As a national field marketing organization (FMO) specializing in the Medicare/Senior Market, we offer independant insurance agents outstanding service, competitive products and top commissions across a wide range of senior products including Medicare Advantage, Medicare Supplement, Final Expense, Funeral Trust, Hospital Indemnity and more.
Source: wordpress.com

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