Fox’s Rove Falsely Claims That Social Security, Medicare Lack Fraud Protection

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The Office of the Inspector General also maintains a program to reduce and respond to SSDI fraud. The Cooperative Disability Investigation Program “investigate disability claims under SSA’s Title II and Title XVI programs that State disability examiners believe are suspicious.” The CDI obtains evidence for disability examiners before benefits are paid and provides reports for continuing disability reviews “that can be used to cease benefits of in-payment beneficiaries.” The program reported $339.6 million in projected savings to SSDI programs in fiscal year 2012. The program also publishes reports on the convictions of the most egregious fraud and abuses of the system found by investigators.
Source: mediamatters.org

Video: Medicaid News – Rick Snyder, Congressional Budget Office, Harry Reid, Medicare

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

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

Daily Kos: Paul Ryan adds Medicare and Medicaid to the ransom note

So far from taking Obamacare off the table, Ryan says he was expanding the playing field to include Medicare and Medicaid as well. Sure, he acknowledged that Obamacare can’t be fully repealed through through the shutdown threat, but: “We’re not saying stop going after Obamacare,” he said. “We’re saying add these other things to this list because we think they’re in this country’s interest, and by the way, in some of these instances, entitlement reform, I think the president might be willing to do this.” When he wrote the op-ed, Ryan might have been trying to limit the scope of the GOP’s demands. But faced with little more than Twitter backlash and a question from Antonin Scalia’s favorite news source, he’s now written an even bigger check for the GOP leadership to cash.
Source: dailykos.com

For Illinois state retirees. What if my current doctor does not accept Medicare Advantage?

Let the person who answers know that you are a state/community college retiree (or even a TRS retiree) dependent on the State sponsored Medicare Advantage Plan. While this Plan was supposed to be comparable, it is not because my doctor (or clinic) does not accept Medicare Advantage Plans. Forcing anyone to change doctors or clinics does not constitute a comparable policy. The Governor and Central Management Services should make sure that I can remain with my doctors and clinic. I should not have to make this sacrifice.
Source: wordpress.com

Commonsense & Wonder: Medicare fraud

The number of Americans suffering from sleep disorders is on the rise, and the Centers for Disease Control and Prevention estimates that almost 70 million people in the U.S. suffer from a lack of sleep, contributing to rises in obesity, hypertension, diabetes and depression, not to mention a loss of concentration and productivity.
Source: blogspot.com

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

Executive Office of Human Services Seeks Waiver of Medicare Three

As a Pioneer ACO, Atrius Health strongly supports the waiver request to CMS and believes such a request will likely result in improved health outcomes while reducing costs for some of the most frail and vulnerable citizens of the Commonwealth. Without the limitation of an inpatient hospital stay, some patients can be directed more appropriately to a skilled nursing facility or receive care in their home with support by home care services provided by community providers, thus reducing expensive and often unnecessary inpatient hospital care.
Source: atriushealth.org

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

OIG hospital audits reveal $2.26M in Medicare overpayments

In response, Southcoast added more case management staff, offered additional education and hired a consultant to help determine inpatient versus outpatient status. While the system agreed with most of the audit findings, it maintained 41 inpatient short stay claims met the medical necessity requirements for inpatient admission and plans to fully appeal the claims, according to the audit.
Source: fiercehealthcare.com

Daily Kos: New report: NC officials edited out information that proves Medicaid isn’t “broken” after all

Sylv, Ducktape, i dunno, Odysseus, Bob Love, Shockwave, Sherri in TX, hyperstation, eeff, xynz, missLotus, Wee Mama, whenwego, highacidity, roses, vmckimmey, jalbert, Iberian, Cedwyn, wader, Redfire, Eric Blair, solliges, beetlebum, lcrp, wordwraith, kismet, zerelda, Sembtex, mungley, Josiah Bartlett, rmx2630, Gowrie Gal, davidincleveland, maybeeso in michigan, Ckntfld, basquebob, Brooke In Seattle, eru, Sun Tzu, jimstaro, Kayakbiker, Phil S 33, markdd, peacestpete, SocioSam, Box of Rain, Dolphin99, BachFan, golem, myboo, Themistoclea, Gorette, aloevera, gpoutney, JVolvo, armadillo, el cid, ER Doc, middleagedhousewife, AllDemsOnBoard, Clive all hat no horse Rodeo, nannyboz, Eikyu Saha, AllanTBG, FlamingoGrrl, North Central, paz3, FishOutofWater, Mary Mike, LamontCranston, millwood, gchaucer2, madgranny, TomP, Empower Ink, VA Breeze, Involuntary Exile, bythesea, Ronald England, lavorare, monkeybrainpolitics, Lujane, rssrai, tofumagoo, Cassandra Waites, TokenLiberal, catly, OrdinaryIowan, watercarrier4diogenes, forgore, rubyclaire, ewmorr, bobatkinson, LibrErica, Denise Oliver Velez, Keith Pickering, stevenwag, ArthurPoet, davespicer, Edge PA, Larsstephens, Amber6541, p gorden lippy, NJpeach, estreya, Susan from 29, secret38b, yellowdogsal, Polly Syllabic, freeport beach PA, Eddie L, AJ in Camden, DiegoUK, rja, nirbama, science nerd, slice, Mister Met, theKgirls, pajoly, I love OCD, spooks51, slowbutsure, vahana, trumpeter, marleycat, sethtriggs, thomask, BarackStarObama, political mutt, floridablue, MRA NY, poliwrangler, VTCC73, FisherOfRolando, SteelerGrrl, jobobo, No one gets out alive, Laurel in CA, Heart n Mind, Siri, We Won, IndieGuy, ahumbleopinion, Joieau, a2nite, Trotskyrepublican, stellaluna, MartyM, BRog, tytalus, Glen The Plumber, live1, UnionMade, poopdogcomedy, Steve in the Library, aresea, Jeff Murdoch, howabout, helpImdrowning, ET3117, OregonWetDog, TheDuckManCometh, underTheRadar
Source: dailykos.com

Medicare Benefits and Cost

Posted by:  :  Category: Medicare

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This fact sheet discusses Medicare cost-sharing requirements. Traditional fee-for-service Medicare imposes deductibles, coinsurance, and copays for Medicare services.  In addition, beneficiaries must pay premiums for receiving Part B (physician) and Part D (prescription drugs) coverage. Medicare does not cover certain essential services, such as vision, dental, and long-term care expenses, and beneficiaries must pay out-of-pocket for these services.  
Source: aarp.org

Video: Medicare Advantage Plan – What Does It Cost?

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

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

2 Parties' Approaches to Fix Medicare

Recently, there has been controversy within Democratic circles. Howard Dean, a physician, former presidential primary candidate and Democratic Party chair, recently wrote an op-ed in the Wall Street Journal that the IPAB should be repealed because it will not control costs, will become essentially a rationing organization and will lead to much added bureaucracy in medical care delivery. He added that rate setting has never worked in the past forty years. Within two days, Peter Orszag, former Director of the Office of Management and Budget for President Obama retorted to the contrary on Bloomberg View. Clearly it is controversial.
Source: vistage.com

Many Consumers Will Pay Too Much for An Exchange Plan

• The Health Resources and Services Administration will be unable make payments for the Children’s Hospital GME Program and vaccine injury compensation claims. The federal government will not have the funds to monitor Ryan White Grants, particularly AIDS drug assistance program grants, emergency relief grants and comprehensive care to ensure that states, cities and communities are complying with statutory guidance and necessary performance. • The Administration for Children and Families will not continue quarterly formula grants for temporary assistance for needy families, child care, social services block grant, refugee programs, child welfare services and the community service block Grant programs. Additionally new discretionary grants, including Head Start and social services programs, will not be made. • The Administration for Community Living will not be able to fund the senior nutrition programs, Native American Nutrition and supportive services, prevention of elder abuse and neglect, the long-term care ombudsman program, and protection and advocacy for persons with developmental disabilities. • The National Institutes of Health will not admit new patients (unless deemed medically necessary by the NIH director), or initiate new protocols, and will discontinue some veterinary services. NIH will not take any actions on grant applications or awards. • The Centers for Disease Control and Prevention will be unable to support the annual seasonal influenza program, outbreak detection and disease treatment and prevention recommendations (e.g., HIV, TB, STDs, hepatitis).
Source: calbrokermag.com

Medicare and Myeloma FAQ | Myeloma Action Team

. Medicare Advantage plans are private health insurance plans that replace traditional Medicare coverage.  There are many types of plans, which cover hospital and doctor services; most offer drug coverage as well.  Under Medicare Advantage plans, the health plan pays health care providers, not the federal government.  Some people pick Medicare Advantage plans because they offer benefits like vision or dental not covered under traditional Medicare.  Others may pick a Medicare Advantage plan so they can stick with a particular plan network (for example, if they had a Blue Cross Blue Shield plan before retirement, and want to keep the same sort of plan afterwards).  
Source: myeloma.org

How much will Obamacare cost me? (cost calculator)

“I think the penalties should be higher, but they are still enough to make the law effective,” said Jonathan Gruber an economist at MIT who was an architect on both the Massachusetts and U.S. health plans. “In Massachusetts we had people flooding in to sign up. You know Americans are almost uniquely law-abiding people, we massively overpay our taxes in terms of what people do in the rest of the world. When you say it is the law to have health insurance I think people will get health insurance.”
Source: fox4kc.com

Firm Relies On Medicare Experience As It Prepares To Open Federal Health Exchange Calls Centers

Posted by:  :  Category: Medicare

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Shortly after the Medicare prescription drug benefit was introduced in 2006, the HHS inspector general found that 44 percent of callers reported problems accessing information — despite a similar 2004 inspector general’s finding — and 21 percent of callers waited so long for responses that they hung up. When Medicare introduced a new prescription drug discount card in 2004, the Government Accountability Office reported that 29 percent of the call-center answers were inaccurate and 10 percent of the calls were disconnected.
Source: kaiserhealthnews.org

Video: Performance Production Services presents Keynote by Medicare Ins Specialist Barbara Hogan

Understanding Medicare Supplemental Insurance

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

The Ins and Outs of Medicare Supplemental Insurance

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

Daily Kos: Damaged Medicare

Medicaid is a state program.  Here are the rules for New Jersey: The Division of Medical Assistance and Health Services (DMAHS) is reinforcing and updating guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients. The following is a list of important points to remember when determining eligibility and discussing this topic with applicants, clients, authorized representatives and families: • 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. … I hope this fills in the gaps on how this rolls.  Every state has similar “estate recovery” programs which are an important feature of “revenue neutral” O’care.
Source: dailykos.com

No change in Medicare benefits under health law

Jodi Reid, executive director of the California Alliance for Retired Americans, worries there hasn’t been enough outreach to seniors and that advocacy groups are spending the bulk of their advertising funds targeting those impacted by the exchange. Her organization, which represents nearly 1 million seniors in California, is putting together a one-page fact sheet to help dispel myths.
Source: spokesman.com

Despite shutdown, most federal spending continues until debt limit is reached

More Sharing ServicesMore Sharing ServicesMore Sharing Services This article originally appeared on watchdog.org. MADISON – Federal sequestration, it seems, has turned out a lot like the closing rounds of the bout between Rocky Balboa and Clubber Lang in the third installment of the “Rocky” movie franchise. Lang, played by the inimitable but badly imitated Mr. T, is pummeling Rocky when the “Italian Stallion” does what he does best: takes punches. “You ain’t so bad. You ain’t so bad,” Rocky shouts at the ferocious Lang after every explosive punch. So it goes for the ferocious sequestration, the $85 billion in automatic budget cuts born through Congress’ inability to get the federal fiscal house in order. As the Washington Post observed in late June, “Sequestration did hit, on March 1 … But it has not produced what the Obama administration predicted: widespread breakdowns in crucial government services.” Case in point, the Department of Defense’s fearsome furloughs. When sequestration was first announced, DOD was looking at some $50 billion in budget cuts and the possibility of issuing 22 furlough days to some 630,000 of the agency’s approximately 800,000 employees. DOD’s share of this fiscal year’s budget cuts dropped to $37 billion, thanks to continuing resolutions, the fact that Defense is one of the few agencies with a fiscal budget in place, and easing by Congress and the president of a Budget Control Act that was supposed to be merciless with its ax. In July, the number of DOD furlough days was halved to 11. As of Aug. 6, the number of furlough days was trimmed to six, meaning that, for most civilian employees, unpaid days off have come to an end. That’s not to say sequestration hasn’t hurt. Just ask the 1,500 civilian employees atWisconsin’s Fort McCoy and the approximately 700 civilian staff members at theWisconsin National Guard who have lost more than a week’s worth of pay and face another round of wage-reducing measures on Oct. 1. But, when pressed, Defense, like countless other federal agencies, found savings. That, ultimately, is the goal of sequestration, no matter how haphazard it may be: to trim more than $1 trillion out of the federal government’s ballooning debt. Congress, weak-kneed as it is about cutting defense spending, helped too. “Since then, Congress has improved most of a large reprogramming that we requested to let us move money into our operating accounts,” a senior defense official said during a briefing last week. “The services have identified some changes that let us reduce costs. And we’ve been aggressive about shifting funds into those service accounts that have the most problems.” For instance, DOD found about $1 billion in savings that it shifted off of worker furloughs from reduced transport costs. The department found it will not have to move “a number of pieces of equipment in Afghanistan … in fiscal ’13,” the senior official said. DOD saved another $9.6 billion in reprogramming requests, delaying contracts and reducing costs in about 200 programs. Money was shifted around to DOD’s operating accounts. Training has been reduced for the Army, flying time trimmed for the Air Force and there have been fewer Navy ship deployments. The Air Force, however, has resumed flying for most of its squadrons and the Army is increasing some organizational training, according to the senior official. But the damage to readiness has been done, he said, and so DOD is asking for more money. “Military readiness is degraded heading into 2014,” the senior defense official said. “We still need several months and substantial funding to recover. And yet, 2014 is a year that’s going to feature great uncertainty, as much as I can remember any time in working with the defense budget, and it may feature some additional austerity.” That uncertainty is the real issue, according to Linda Fournier, Fort McCoy’s public affairs officer. “If (Congress) could pass a budget, have the money divvied out to say, ‘Here’s your pot of money. Make it work.’ That would speak volumes to what we are able to do,” Fournier said. “It’s difficult when you don’t have that placed with all these things in front of you.” The lack of a new budget is certainly something most federal agencies have faced for several years. The biggest problem with sequestration, critics contend, is its sightless approach to budget cuts, and what many see as Congress’ insatiable hunger to spend. Fournier said Congress forces DOD to purchase outdated weapons and defense equipment in the name of political expediency and refuses to deal with DOD-recommended base closures that would bring significant savings to taxpayers. DOD spokeswoman Jennifer Elzea agreed that Base Realignment and Closure is the domain of Congress, which has not allowed the department to conduct its realignment plan. “We have excess inventory in land and facilities,” Elzea said. That overcapacity is costing billions upon billions of dollars each year to operate. Elzea said a colleague more familiar with BRAC issues was not available for comment on Monday; he was on furlough. Fort McCoy, meanwhile, cut its maintenance and repair budget by some $6 million, Fournier said. The installation’s six days of furloughs will save about $1.8 million. Fournier said budget cuts have created more inconveniences at the fort, from potentially longer security check times to shifts in responsibilities and staff vacancies going unfilled longer. But federal agencies, like DOD, are discovering budget items to trim or cut out. The Justice Department, according to the Washington Post, staved off furloughs by “cutting” $300 million in funds that already had legally expired, not to mention $45 million to house detainees who didn’t exist. Those kinds of phantom-like expenditures are the kinds of things that make taxpayers see reason in dramatic across-the-board federal spending cuts. But on other occasions, pressed with budget-cutting deadlines, agencies find all sorts of savings they never thought possible. Fournier compares federal agencies’ quest for savings to a family household budget. “Say they have a car that’s 10 years old. They’d like to buy a new one, but instead of spending $25,000 to buy a new car, they decide to put $2,000 into fixing the old one,” she said
Source: nbcnews.com

Website: Good links/info Medicare Part D Prescription Insurance

This community is part of the Ben’s Friends network of patient communities. Learn more at bensfriends.org. Patient Communities Acute Disseminated Encephalomyelitis (ADEM) ADHD/ADD Adrenoleukodystrophy (ALD) Amyloidosis Arteriovenous Malformation (AVM) Ataxia (International) Ataxia (U.S.A.) Atrial Septal Defect Brain Aneurysms Charcot Marie Tooth (CMT) Chiari Malformation Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Crohn’s Disease Disabilities Eagle Syndrome Ehlers-Danlos Syndrome Erythromelalgia Fabry Fibromyalgia Glossopharyngeal Neuralgia(GPN) Guillain-Barre Syndrome (GBS) Lupus Lyme Disease Multiple Myeloma Myositis Narcolepsy Nephrotic Syndrome Primary Sclerosing Cholangitis (PSC) Psoriatic Arthritis (PsA) Sjogren’s Syndrome Synovial Sarcoma Traumatic Brain Injury (TBI) Trigeminal Neuralgia (TN) Von Willebrand’s Disease (VWD) Other Rare Diseases
Source: livingwithfibro.org

Make Sure Your Retirement Is Worry

As each of us grows older, we require medical assistance more and more. As you enter retirement, it is important to make sure you are prepared for these costs and have the right coverage. It is common to have many questions about Medicare and Medicare Supplement Insurance. Here at Brisotti & Silkworth Insurance, we are ready to answer your questions and help you set up a plan that will completely protect you. Give us a call today at 855-337-6062 and let us help you set up Brookhaven NY Medicare Supplement Insurance.
Source: bsiins.com

Starting the Dialogue with Your Aging Parents About Medicare Part B

may not cover certain items if there is other insurance that will pay or if there is Medicaid coverage. It is very important to know and understand what services are covered and what charges the patient or coinsurance will be responsible for prior to scheduling appointments, receiving services such as lab tests and radiology procedures, or seeking durable medical equipment and supplies.
Source: wordpress.com

Health Department Announces Clinic Schedule for Week of Oct. 14

- Immunization Clinic: Tuesday, Oct. 15, 12:30 to 3:30 p.m., walk-in clinic. – Pregnancy Testing: Free pregnancy testing is available. Call 349-3391 to schedule an appointment. – Sexually Transmitted Disease Testing and Treatment Services: Call 349-3547 to schedule an appointment. – HIV Counseling and Testing Service:  Call 349-3547 to schedule an appointment.
Source: oswegocountytoday.com

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October 11, 2013

Medicare, Medicaid To Keep Running Despite U.S. Government Shutdown – WebMD

Posted by:  :  Category: Medicare

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If you select “Keep me signed in on this computer”, you can stay signed in to WebMD.com on this computer for up to 2 weeks or until you sign out. This means that a cookie will stay on your computer even when you exit or close your browser which may reduce your levels of privacy and security. You should never select this option if you’re using a publicly accessible computer, or if you’re sharing a computer with others. Even if you select this option there are some features of our site that still require you to log in for privacy reasons.
Source: webmd.com

Video: medicare vs medicaid

Why Do Conservatives Support Medicare and Medicaid?

I suspect that one of the reasons that many conservatives admire and even envy libertarians is over our consistency of principle. (Of course, some conservatives hate us and resent us for the same reason.) We oppose socialism and favor we free markets, just as conservatives say they do. But, unlike them, we actually oppose Medicare and Medicaid and call for their repeal. We don’t concern ourselves over whether the mainstream press likes us or considers us credible. What’s important to us is that we stand for what we believe in. We fully understand that statists don’t like what we believe in. Why should that matter? Why should that cause us to hide our views or change them?
Source: lfb.org

UnitedHealthcare Cuts Doctors From Medicare Advantage Network

UnitedHealthcare is one of a number of insurers that offer Medicare Advantage plans in Connecticut and across the nation. Medicare Advantage plans are a type of federal-government-funded health-care plan offered by private insurers to people age 65 and older. Insurers contract with the federal government to provide Medicare Parts A and B, which is hospital and medical coverage, respectively. A Medicare Advantage plan may also provide additional coverage, such as prescription drug benefits.
Source: courant.com

Fox’s Rove Falsely Claims That Social Security, Medicare Lack Fraud Protection

The Office of the Inspector General also maintains a program to reduce and respond to SSDI fraud. The Cooperative Disability Investigation Program “investigate disability claims under SSA’s Title II and Title XVI programs that State disability examiners believe are suspicious.” The CDI obtains evidence for disability examiners before benefits are paid and provides reports for continuing disability reviews “that can be used to cease benefits of in-payment beneficiaries.” The program reported $339.6 million in projected savings to SSDI programs in fiscal year 2012. The program also publishes reports on the convictions of the most egregious fraud and abuses of the system found by investigators.
Source: mediamatters.org

Affordable Care: parent on Medicare/Medicaid, son needs options

Missouri is not planning to expand Medicaid, so you are also correct that you will not qualify for that.  Many health economists believe that all states will eventually take the Medicaid expansion.  So, perhaps in the future, you will be able to apply for Medicaid.  In your state, you will also not qualify for subsidies to purchase a plan on the health insurance exchanges.  It’s a strange situation in these states: people earning less than 133% of Federal Poverty ($15,282 for a one-person household) cannot get subsidies.  People earning 133% or more do get subsidies.
Source: bangordailynews.com

What is the difference between Medicaid and Medicare?

Comparing Medicaid vs Medicare is extremely important to understanding the health care insurance you may qualify to receive. Some individuals with a extremely low household income may qualify for Medicaid and Medicare. In that case, most medical and prescription drug needs are covered without having to purchase additional health insurance coverage.
Source: qooqe.com

Visualizing Health Policy: The Role of Medicaid and Medicare in Women’s Health Care

This month’s Visualizing Health Policy infographic provides information about the role of Medicaid and Medicare in women’s health care: the proportion of US women who are covered by Medicaid and Medicare; how women comprise the majority of those covered by the Medicaid and Medicare programs and the majority of those receiving long-term services and supports (such as home health care); how women on Medicaid are poorer and sicker than women with private coverage; how Medicaid is a primary payer for women’s reproductive health services; and how women on Medicare spend more than their male counterparts on medical care and also have higher rates of health problems and social challenges.
Source: kff.org

Houston We Have a Problem

First though, I have to laugh about a lot of conversations I have with dentists about compliance and their need to ensure they have systems in place to protect their dental practices, and what those systems even look like. Some dentists look at me like I’m crazy (right on there). The problem is they give me all kinds of avoidance tactics (B.S.) about how they are good and don’t need me or they have a compliance person. Hey I’m not offended, you’re just not up-to-speed and your ‘compliance’ person doesn’t know crap (I would expect you to tell me I don’t know crap about dentistry, which is true, so we’re even)!
Source: dentalcompliance.com

Medicaid and Medicare Under Rep. Ryan’s Budget

Congressman Paul Ryan (R-Wis.), unveiled his budget yesterday, proposing cuts of some $6.2 trillion over the next decade. Medicare and Medicaid will fundamentally change under Ryan’s plan — with Medicare losing $389 billion, and $735 billion being cut from Medicaid. Todd Zwillich, The Takeaway’s Washington correspondent details what parts of the budget will affect Americans the most. Theda Skocpol, professor of sociology and government at Harvard University, explains how Medicare and Medicaid will change under Ryan’s plan.
Source: thetakeaway.org

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October 11, 2013

Best Medicare Supplement Companies

Posted by:  :  Category: Medicare

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Plan F is one that many choose that helps them to get all of their basic benefits including co-payments. Those who choose this option may not end up ever having to pay another medical bill, and that can be a huge help to those who want to save a lot of money and stay healthy. This plan is a little bit more expensive, but it is probably the most popular for seniors. Another great option is the plan G, which is better for those who are just looking to save some money. It has a deductible, but also offers something for those who want to try home recovery. Also, there is plan C, which covers a lot and costs a little bit less than the first option. The best way to sort through all these options is to get get a set of Medicare supplement quotes so you can make the best choice for your needs.
Source: privatehealthinsuranceuk.org

Video: Supplemental Medicare Insurance – Steps To Choosing The Best Medicare Supplement

Which Is The Best Excellent Quality Medicare Supplement Leads

www.medicaresupplementplanfguide.com Plans approximately persistently offer higher exposure to it : to Medicare-Advantage-Plans, which is why quite a lot of people really are opting to store in normal Medicare health insurance and buy supplemental-insurance. A dealership of seniors a lot more than the years suffer from received correspondences stating to them of specific coverage with that current benefit intend will be through at the finalize of the ongoing year. These insured adults already have a special more confident issue time frame, where they might register in any kind of want with any broker without giving types to any associated the health factors. People who experience physical conditions as issues should start using this period returning to buy a Treatment Supplemental quote.
Source: tampabaysharepoint.org

FAQ: What is Medicare Supplement (Medigap) Insurance?

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

Top 10 Reasons to Sign Up for a Medigap Plan

Medigap plans use underwriting. These seems like it would not be a reason to sign up for a Medigap plan. But on the contrary, this is a crucial reason for signing up for a plan when you are eligible. Eligibility is granted by turning 65, losing employer coverage, losing Advantage plan coverage, signing up for Part B for the first time, and several other specific instances. If you do not sign up during one of these periods, you would have to qualify medically for a plan and can be denied coverage or made to pay more (even AFTER 1/1/14 and PPACA).
Source: medicare-supplement.us

The Ins and Outs of Medicare Supplemental Insurance

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

Easy Methods To Find The Best Way To Supplement Medicare Health Insurance Benefits

Our website is dedicated to new data for medicare plan f buyers. We present you all information that you requirement on medicare with medicare supplement insurance policies. You can read through all the material that is provided on our online shop. Once you figure out what needs are in regards to a medigap policy, you can distinction quotes on our website from various insurance providers. Over twenty leading private insurance firms offering medigap insurance plans are registered along with us. Often many of them offer the same benefits sadly at sharply totally different prices. We will help you find the cheapest.
Source: gshrss.com

Medicare Supplement Quotes

Quotes on Medicare supplement insurance coverage are easy to obtain online. All you need to do is answer a few questions and an online quote generator can tell you how much that insurer will charge for coverage. Be sure to read all information about a policy before buying as not all Medigap policies are the same. If you have a Medicare Advantage plan, in most cases you’ll want to drop it before your new Medigap policy starts coverage.
Source: skepticwiki.org

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

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

Medigap vs. Medicare Advantage Plan

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

Why You Need Their Medicare Supplement Strategize

Some sort of two major requirements to go in addition to a supplement tactics instead of a major Advantage plan is the freedom to be able to choose your doc and hospital, besides that many of some of the supplement plans pick-up all the expenditure that Medicare does not pick to the top level. When an individual choose a vitamin supplements plan check offered which ones repay for your Surgery deductible and which will ones pay your incredible deductible for doctor visits. Always remember you will have to enroll on its own in a medical prescription plan too. If you commonly do not take many pain medications now you may go with a meaningful basic plan to make now. year one will often change his prescription plan.
Source: thatguyoverthere.com

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October 11, 2013

Which Is The Best Excellent Quality Medicare Supplement Leads

Posted by:  :  Category: Medicare

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www.medicaresupplementplanfguide.com Plans approximately persistently offer higher exposure to it : to Medicare-Advantage-Plans, which is why quite a lot of people really are opting to store in normal Medicare health insurance and buy supplemental-insurance. A dealership of seniors a lot more than the years suffer from received correspondences stating to them of specific coverage with that current benefit intend will be through at the finalize of the ongoing year. These insured adults already have a special more confident issue time frame, where they might register in any kind of want with any broker without giving types to any associated the health factors. People who experience physical conditions as issues should start using this period returning to buy a Treatment Supplemental quote.
Source: tampabaysharepoint.org

Video: FREE MEDICARE ADVANTAGE LEADS/FREE MEDICARE ADVANTAGE APPOINTMENTS

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

Gross said anyone choosing to return to original Medicare has a guaranteed right to buy a Medicare supplement policy to help pay health care costs that Medicare does not cover. That means the insurance company must sell them a policy, must cover pre-existing conditions and cannot charge more because of past or present health problems.
Source: thegazette.com

No more Medicare Advantage leads

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

Medicare Advantage Leads for Sale

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

May Medicare Advantage Especially An Advantage

Medicare Plan F Plans approximately persistently offer higher introduction to Medicare-Advantage-Plans, generally is why a whole lot of people get opting to logon in normal Treatment and buy supplemental-insurance. A yard of seniors a lot more than the years gain received correspondences stating to them of specific coverage with the current benefit scheme will be through at the end of the current year. These insured adults want a special feeling good issue time frame, where they may well register in all kind of plan with any office without giving information to any of the health inquiries. People who experience physical conditions as well as issues should use this period so that you buy a Medicare Supplemental quote.
Source: fdnyretireesofcalifornia.com

Medicare Advantage menu shrinks

The Medicare Advantage program – an initiative that resembles the public exchange program that the Patient Protection and Affordable Care Act (PPACA) is creating – gives private organizations a chance to offer Medicare enrollees an alternative to traditional Medicare coverage.
Source: lifehealthpro.com

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October 11, 2013

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

Posted by:  :  Category: Medicare

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

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

CMS National Training Program Medicare Workshop 2013

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

Q. I have Medicare and have heard my Medicare coverage needs to be reviewed annually. Could you give me more information about this? Shelley in Conyers, GA

First, it is important to be fully aware of your specific current coverage within each of the above types. This is often best found by reviewing the insurance cards that you currently provide to your medical and pharmacy providers. With every insurance there will be a carrier (or company providing the insurance) and a specific name/type of the insurance on the front of the card. Know there are often annual changes to the Medicare Advantage and Medicare Prescription Drug plans that you currently have – so, it will be important to review any upcoming changes with your current plan providers to be aware how they might “act” in the upcoming year. For example, a drug covered in 2013 by your drug plan might not be covered by your plan in 2014. Or, a hospital that was in-network under a Medicare Advantage plan in 2013 might no longer be within the network for 2014.
Source: seniorcareopt.com

Georgia, South Carolina not expanding Medicaid

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

Medicare: It is About Medical Necessity

Notice that there is nothing in the above statement discussing the Medicare Cap or Manual Medical Review, because neither of those things have anything to do with your obligations to treat the patient as a Medicare Provider.  Medically necessary PT,OT, and Speech treatment are included in the patient’s Medicare benefits. Since there is an automatic exception to the cap, medically necessary treatment should never be delayed or stopped because the patient has reached the Cap or MMR Review.
Source: clinicient.com

Augusta needs Medicaid expansion, and so does Georgia

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

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

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

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October 11, 2013

Medicaid Waiver Fosters Collaboration, North Texas Hospital CEOs Say

Posted by:  :  Category: Medicare

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The Texas Medicaid Waiver 1115 is formally known as the Texas Health Care Transformation and Quality Improvement Program. The waiver was a response to the expansion of Medicaid managed care during the 2011 legislative session. The federal government reduces upper payment limit funding under HMOs, and UPL payments were designed to help compensate for the fact that Medicaid only pays hospitals about half of the cost of care. The program pays Texas hospitals about $3 billion annually.
Source: dmagazine.com

Video: What Are The Differences Between Medicare and Texas Medicaid

Does Obamacare’s Medicaid Expansion Affect You?

Some states, like California and North Dakota, have chosen to take the expanded funding under Obamacare and expand Medicaid coverage to 133 percent of the federal poverty level (up to $32,500 for a family of four). Other states, like Texas and Pennsylvania, will still offer Medicaid coverage based on the state’s own rules for eligibility, but will not be taking federal funding to increase coverage.
Source: findlaw.com

Texas Home Health Companies Sue Government Over Medicare Privileges

AAHomecare AARP Almost Family Almost Family Inc. Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Brookdale Senior Living CellTrak Technologies Inc. Center for Medicare & Medicaid Services Centers for Medicare & Medicaid Services CliftonLarsonAllen CMS Department of Health and Human Services Department of Justice Emeritus Senior Living featured Federal Bureau of Investigation Gentiva Health Services Inc. HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare Kindred Healthcare Inc. LHC Group NAHC National Association for Home Care & Hospice New England Home Healthcare Consortium New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Health Care Partnership for Quality Home Healthcare PHI Scripps Health The Ensign Group The Partnership for Quality Home Healthcare VA Visiting Nurses Association Visiting Nurse Service of New York Wall Street Journal
Source: homehealthcarenews.com

MedicareBob’s Blog: Anderson County Texas Medicare Supplement Quotes

The three most comprehensive Medicare Supplement Plans are: Medicare Supplement Plan F: Full Coverage Medicare Supplement Plan G: Small Deductible ($147.00) Medicare Supplement N: Small Deductible & Copays (Part B Excess
Source: blogspot.com

Atascosa County Texas Medicare Supplement Quotes

Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Atascosa County Texas, Atascosa County Texas Cheapest Medicare supplement rates, Atascosa County Texas cost effective Medicare supplement rates, Atascosa County Texas Medicare, Atascosa County Texas Medicare Supplement Quotes, Atascosa County Texas Medicare Supplements, Atascosa Texas supplement quotes, Best Supplement, Cheapest Premium, Cigna Supplement, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, Texas Medicare, Texas Medicare Agent, Texas Medicare Supplement Quotes, United Healthcare Supplement, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Medicare gives Texas hospital 90 days to shape up

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

LIVE from MGMA13: Medicare ACOs Share Their Real

Nuckolls: For our ACO, with 11,000 members, we must show savings of greater than 2.9 percent before we are to achieve savings. Some of the strategies include how do we reduce ER visits and unnecessary hospitalizations? Having one hospital, we have it a little easier than others. We have someone who looks at emergency department (ED) summaries and admission summaries every day to look for opportunities. And we have found many opportunities, where patients can go to the doctor rather than the ER. Once we see those things, we can create the right culture. The more access you have for patients, the better—they don’t want to go to the ER and wait for six hours.
Source: healthcare-informatics.com

Who Pays For Hospice Care In Texas?

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

Texas Children’s Hospital Goes To Court Over Medicaid Cutback

“We’re trying to balance being available for all our kids, we don’t differentiate by who can pay. So when 55% of our kids are Medicaid, you know, we want to balance that equation to figure out a way to sustain ourselves on that.”
Source: kuhf.org

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October 11, 2013

DAR File No. 37976 (Section R414

Posted by:  :  Category: Medicare

Section R414-1-5 is changed to incorporate the State Plan and approved State Plan Amendments (SPAs) by reference to 10/01/2013. These SPAs include: SPA 13-008-UT, Psychologist Services, which updates and modifies the psychologist sections of the State Plan for clarification purposes; SPA 13-018-UT Medical Education Payments, which updates the graduate medical education payment pool methodology based on specified percentages to specified hospitals; and SPA 13-020-UT Preadmission Screening by Categorical Determination, which allows the Department to add the Short Stay Categorical Determination as a new category type. This new category allows an individual who suffers from an acute physical illness in a community setting to be admitted directly to a nursing facility for a short stay to stabilize the illness. This rule change also incorporates by reference the Medical Supplies Utah Medicaid Provider Manual; the Hospital Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Speech-Language Services Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Audiology Services Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Hospice Care Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Personal Care Utah Medicaid Provider Manual, with its attachments, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 10/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 10/01/2013; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, effective 10/01/2013; Office of Inspector General Administrative Hearings Procedures Manual, effective 10/01/2013; Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Coverage and Reimbursement Code Look-up Tool, effective 10/01/2013; Certified Nurse – Midwife Services Utah Medicaid Provider Manual, effective 10/01/2013; CHEC Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Chiropractic Medicine Utah Medicaid Provider Manual; Dental Services Utah Medicaid Provider Manual, effective 10/01/2013; General Attachments for the Utah Medicaid Provider Manual, effective 10/01/2013; Indian Health Utah Medicaid Provider Manual, effective 10/01/2013; Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Medical Transportation Utah Medicaid Provider Manual; Mental Health Centers/ Prepaid Mental Health Plans Utah Medicaid Provider Manual, effective 10/01/2013; Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual, effective 10/01/2013; Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual; Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, effective 10/01/2013; Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Podiatric Services Utah Medicaid Provider Manual; Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; Psychology Services Utah Medicaid Provider Manual; Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 10/01/2013; Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual, effective 10/01/2013; Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments, effective 10/01/2013; School-Based Skills Development Services Utah Medicaid Provider Manual, effective 10/01/2013; Section I: General Information of the Utah Medicaid Provider Manual, effective 10/01/2013; Services for Pregnant Women Utah Medicaid Provider Manual, effective 10/01/2013; Substance Abuse Treatment Services and Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual, effective 10/01/2013; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 10/01/2013; and Vision Care Services Utah Medicaid Provider Manual, effective 10/01/2013.
Source: utah.gov

Video: Utah Medicare Advantage Plans for Seniors in 2012

MedicareBob’s Blog: Washington County Utah Medicare Supplement Quotes

The three most comprehensive Medicare Supplement Plans are: Medicare Supplement Plan F: Full Coverage Medicare Supplement Plan G: Small Deductible ($147.00) Medicare Supplement N: Small Deductible & Copays (Part B Excess
Source: blogspot.com

Utah County Utah Medicare Supplement Quotes

Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Best Supplement, Cheapest Premium, Cigna Supplement, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, United Healthcare Supplement, Utah County Utah, Utah County Utah Cheapest Medicare supplement rates, Utah County Utah cost effective Medicare supplement rates, Utah County Utah Medicare, Utah County Utah Medicare Supplement Quotes, Utah County Utah Medicare Supplements, Utah Medicare, Utah Medicare Agent, Utah Medicare Supplement Quotes, Utah Utah supplement quotes, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Utah Medicare Plans 2013 and beyond

Medicare in Utah and throughout the U.S. has had a scare recently because of the passage of the Affordable Care Act, otherwise known as Obamacare. The people in charge, on both sides of the aisle,  want to try and scare us all with threats of cuts and drastic changes to Medicare Plans in Utah. While there is some concern for the future about how the federal government is going to be able to afford all their new ideas about national healthcare, it appears as though Medicare plans and Medicare coverages are going to be ok for the time being. Utah Medicare Advantage plans and plans nationwide have seen a 3.3% increase for funding for the 2014 calendar year, and by all appearances that should continue down the same path for the next 10 years or so barring a complete collapse of our financial system. As always it is best to have an agent or advisor who can help you wade through all questions you may have. Feel free to call us with any questions 801.979.6365
Source: utahseniorservices.com

Utah's Largest Cancer Clinic System Is Sending Away Medicare Chemo Patients, Per Obama's Sequestration Cuts

The Utah situation is a repeat of what is happening to community cancer clinics across the country. The Obama Administration refuses to take action. A bill to restore full funding for Medicare chemotherapy was filed April 9 by Rep. Renee Ellmers (R-N.C.), whose office is providing updates on the impact of the cuts to Medicare chemo patients in her state. The bill is HR 1416, "Cancer Patient Protection Act of 2013," which so far has remained in a House Subcommittee since April 12. HR 1416 has a bipartisan group of 56 co-sponsores as of today.
Source: larouchepac.com

Practical Ideas On How To Become A Major Medicare Provider In Utah

The particular few but crucial differences are relating the types having to do with medigap policies. Coverages K not to mention L have most differences linked with all the software programs that are readily obtainable. These two usually are based on small amount rates normally somewhere between 50 and 75 percent. Plan C providing less areas as plans A suitable thru J. Considered the absolute best choice, Plan C provides better insurance plan on co-payments forward plans A additionally B for any in need for greater Medigap Car insurance coverage. From year to finally year Plans K and L will certainly be limited by- out-of pocket expenditures which can guide ensure those older folks are not commit more for your particular plans defense.
Source: edublogs.org

NewsDaily: Myriad Genetics recovers after Medicare rate woes

Myriad has sued two competitors to stop them from selling a genetic test that competes with BRACAnalysis. Those companies launched their tests in June following a Supreme Court ruling that companies cannot patent genes that are naturally found in the body, a ruling that analysts say will open the door for competing tests and additional scientific research. The court said synthetically created genetic material, called complementary or cDNA, can be patented.
Source: newsdaily.com

DownWithTyranny!: Ryan Pivots Away From Cruz For Boehner

Cuccinelli, struggling to stay in the 30’s in recent polls, has already started cutting back on media spending. He knows he lost. The hit the Republican brand took during his gubernatorial campaign was too great to iovercome– even as his opponent, corrupt political wheeler-dealer Terry McAuliffe, was one of the most flawed and unattractive candidates the Democrats could have possibly put up. Gallup shows the GOP at the lowest approval rating– 28% and rapidly dropping– ever! Even Ted Cruz’s Utah Tea Party lackey, Mike Lee, has seen his approval among home state voters evaporate since he went on his shut down the government crusade. “57% of Utahns overall would like Senator Lee to be “more willing to compromise” versus 43% who prefer that he “stand by his principles.” That result is not possible in Republican-dominated Utah without at least some Republicans preferring compromise.  In fact, 38% of all self-identified Republicans prefer that Lee compromise compared to 99% of all Democrats.  Independents side heavily with compromise at 65%.” And Erick Erickson is predicting a full scale Republican civil war and a breakaway third party.
Source: blogspot.com

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October 11, 2013

News Article/Update on State Medicare Advantage Plans

Posted by:  :  Category: Medicare

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Impacted SURS members will receive an initial letter from CMS regarding the vendor changes and the steps they will need to take regarding their health insurance coverage. The letter will explain the plan design (including copayments, deductibles and coinsurance percentages), provider networks and maps, enrollment dates, effective date of the new coverage, monthly premiums, opt-out information, and informational seminar dates. The initial letter will go out within the next few weeks.
Source: surs.com

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

Notices About Medicare Advantage Changes Coming

The Oregonian: Medicare Advantage Plan Changes Arriving In The Mail  Seniors: keep an eye on your mailboxes this week. Medicare Advantage plans will be mailing required notices of how their benefits and costs will change in 2014. Seniors can join, switch or drop health and drug plans for the coming year between Oct. 15 and Dec. 7. Before all that, plans must provide letters detailing any changes in coverage or cost by Sept. 30. If you get one, be sure to review it and understand the changes made (Hunsberger, 9/26).
Source: kaiserhealthnews.org

Medicare Advantage plan fastracks contract suppliers

“If this were to happen on a wide scale, the carrier would be terminating hundreds—maybe thousands—of contracts to trim down to the very small number of folks that are eligible to supply DME under the program,” said Poole, vice president of operations at Benefits365. “You hear of instances where one particular carrier is making certain adjustments, but there’s usually no blanket response.”
Source: hmenews.com

2014 Medicare Advantage Plans

Medicare Advantage plans are offered by private insurance companies that contract with Medicare. These plans must offer at least the same amount of coverage as Original Medicare (Part A and Part B), and may also offer additional coverage such as vision, dental, and prescription drug coverage. During the Medicare Annual Election Period, also known as the Annual Enrollment Period or the Open Enrollment Period, beneficiaries may make changes to their Medicare Advantage coverage. Providers may change their plan details each year, so it is recommended that beneficiaries review the 2014 benefits for their Medicare Advantage plan to be sure that the plan they are enrolled in is still the right one for their needs.
Source: planprescriber.com

Fewer Medicare Advantage plans in 2014, analysis finds

Factors for the drop in MA plans include continued phase-in of payment cuts under the Affordable Care Act, modifications to the CMS risk-adjustment model, implementation of new medical loss ratio requirements for Medicare Advantage, and application of the new health insurer fee, Avalere noted. Around 80% of counties in Southern and Midwestern states will see a reduction in MA plan options. Click here to see a table of Medicare Advantage plans by type. 
Source: mcknights.com

Medicare Advantage Plan San Diego And Its Enrollment

Medicare Advantage is one of the options available to Medicare Recipients. It combines Medicare Part A, B and often D coverage and is offered by private insurance companies. MA Plans must provide all of the services covered by Original Medicare but usually at a lower cost. Each can charge different co-payments and have rules for how you get services (like whether you need a referral to see a specialist or if you have to go to network only doctors for non-emergency care). To be eligible for that kind of plan you must have Medicare Part A and B, live in the plan’s service area and you can’t have End-Stage Renal Disease (permanent kidney failure).  Most plans in San Diego County have no additional monthly premium and include prescription drug coverage (Part D). MA plans offer a variety of preventive tests and checkups at $0 co-payment, additional benefits like vision, dental, fitness club membership and transportation as well as discounts for product and services.
Source: pomeradonews.com

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

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