“If I get denied Medicaid then I’ll come see you”

Posted by:  :  Category: Medicare

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I explained that just because the trust is irrevocable doesn’t by itself tell me whether it is subject to New Jersey’s Medicaid spend down requirements or not.  And her reference to a living trust confused things even more because most people use that term to refer to a revocable trust.   Assets in a revocable trust definitely are subject to Medicaid’s spend down requirements and assets in an irrevocable trust may or may not, depending on what access Mom has to it.  The only way to know would be for me to get a copy of the trust agreement and read it.  There is no such thing as a “standard” irrevocable trust.
Source: hauptmanlaw.com

Video: Can I “spend down” to qualify for Medicaid?

Fact Check:Will Increased Longevity Bring Down Medicare?

The customary formulation of this myth is that Medicare is doomed by its own success in keeping its beneficiaries alive. Not only will the ranks of the program’s beneficiaries increase as the vaunted baby boom generation reaches the statutory age of eligibility, but because people are staying alive longer, Medicare’s costs will explode. The first part of this contention is indisputably true: entitlement to Medicare occurs when a person reaches age sixty-five, and the baby boom generation that is generally calibrated as starting in 1946 has arrived at that threshold. As a result, additional Medicare beneficiaries enter that program every day, and because the baby boom generation dwarfs any preceding age cohort, it is highly likely that more beneficiaries will be added to the program than are lost as older beneficiaries pass away. Consequently, the number of Medicare beneficiaries will inexorably increase over the next decade or so. Ceteris paribus, more beneficiaries mean higher aggregate costs.
Source: thehealthcareblog.com

Creative Medicaid Spend Down Techniques (May 2013)

. Even though the home is considered an exempt asset to get qualified for Medicaid, the State can and will place a lien on your home once you do qualify for nursing home Medicaid so that they can recover every penny they have spent on your care after you pass away. Usually if you give away any asset within 5 years of applying for Medicaid—including your home—you will have a penalty period assessed to you during which time Medicaid will not pay for your care even if you have less than $2,000. One exception to this rule is a transfer of your home to an exempt “caregiver child”. If you have a child who has lived with you in your home for the 2 years prior to your entering a nursing home, and that child helped to take care of you, then you may transfer your home to that child with no penalty under the 5 year lookback rule. We had a client come to us who had no children, but his favorite nephew lived with and took care of him for 10 years. He wanted to leave his house to his nephew, but there is no “caregiver nephew” exemption in the law. So we helped uncle to adopt his 45-year old nephew as his son. Then we had uncle transfer his house to his nephew, who was now legally his child and it qualified as a transfer to an exempt caregiver child. Uncle got qualified for Medicaid immediately after that and the State could not put a lien on his home. The home was safely owned by the nephew and protected from a Medicaid lien.
Source: okuralaw.com

STRATEGIES TO AVOID NURSING HOME SPEND

If you are single, Medicaid will tell you that you will have to spend-down all of your Countable Assets until you have only $2,000 remaining. You will then be eligible for Medicaid assistance. If you are married, Medicaid will tell you as the spouse at home that you may keep $113,640 in Countable Assets (with an additional $2,000 for the spouse in the nursing home). You will therefore need to spend-down all of your Countable Assets until you reach the total of $115,640. Again, remember these are Florida Rules.
Source: swfhealthandwellness.com

Government shutdown and debt ceiling FAQ

What would happen if the debt ceiling were not raised? The government would have to immediately stop all spending in excess of revenues, which would be a reduction of about 30%. That would mean ending almost all entitlement spending, on things like Medicare, Medicaid, farm subsidies, food stamps, housing subsidies, education subsidies, and payments to government-funded pension funds. Arguably Social Security benefits could continue as long as enough FICA taxes were collected, but since those taxes are not keeping up with benefits, those benefits would have to be reduced, and continue to fall. Advocates of more spending and borrowing make the Keynesian argument that a sudden cutoff would be disastrous to the economy. There would almost certainly be a shock from any sudden change in government spending, and many enterprises that have grown to depend on it might go bankrupt, but reduced government borrowing would also make more investment funds available to other things, like expanding businesses, creating jobs, and investing in new technologies, so after a period of adjustment, the net effect is likely to be beneficial to the economy.
Source: tenthamendmentcenter.com

If I Get Denied Medicaid, Then I will Contact You

I explained that just because the trust is irrevocable doesn’t by itself tell me whether it is subject to Massachusetts’ Medicaid spend down requirements or not.  And her reference to a living trust confused things even more because most people use that term to refer to a revocable trust.   Assets in a revocable trust definitely are subject to Medicaid’s spend down requirements and assets in an irrevocable trust may or may not, depending on what access Mom has to it.  The only way to know would be for me to get a copy of the trust agreement and read it.  There is no such thing as a “standard” irrevocable trust.
Source: estateplanandassetprotection.com

In brief: Health spending ‘on right track,’ Medicare Advantage enrollment to grow

ANN ARBOR, Mich. – For people suffering from sleep apnea, sticking with CPAP treatment can yield a nice fringe benefit—a more alert, youthful and attractive appearance, according to a new study published Sept. 13. As part of a small study, researchers at the University of Michigan employed a face-mapping technique on 20 middle-aged sleep apnea patients within a few months of the start of CPAP use to compare before and after photographs. “The common lore, that people ‘look sleepy’ because they are sleepy, and that they have puffy eyes with dark circles under them, drives people to spend untold dollars on home remedies,” said lead researcher Ronald Chervin, a professor at the University of Michigan. “We perceived that our CPAP patients often looked better or reported that they’d been told they looked better after treatment. But no one has ever actually studied this.” Facial mapping found less puffiness in the foreheads and less redness in the face of patients who used CPAP therapy. Researchers also perceived fewer forehead wrinkles. They were surprised, however, to see no improvement in dark circles or undereye puffiness. 
Source: hmenews.com

US health spending projected to grow an average of 5.8 percent annually through 2022

But starting in 2014 growth in national health spending will accelerate to 6.1 percent, reflecting expanded insurance coverage through the ACA, through either Medicaid or the marketplaces. The use of medical services and goods, especially prescription drugs and physician and clinical services, among the newly insured is expected to contribute significantly to spending increases in Medicaid (12.2 percent) and private health insurance (7.7 percent). Out-of-pocket spending is projected to decline 1.5 percent in 2014 due to the new coverage and lower cost sharing for those with improved coverage.
Source: sciencecodex.com

Mo. To Change Medicare 'Spend Down' Rules

Alyson Campbell, the director of the Department of Social Services’ Family Services Division, told lawmakers that, in some cases, department staff had been incorrectly giving credit for the full amount of a person’s medical bill – even if parts of it were paid for by Medicare or private insurance or were written off altogether by the person’s medical provider. That means some people in the program might have received Medicaid coverage for which they were not truly eligible.
Source: kmbc.com

Medicare Penalties To Top A Quarter Million Dollars For Select Readmissions

Posted by:  :  Category: Medicare

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The American College of Surgeons expressed concerns in a letter to CMS signed by David B. Hoyt, MD, FACS, Executive Director. In it, ACS notes, “While we understand that excess readmissions can be an indicator of poor quality of care and wasteful spending, we urge CMS not to further expand the Hospital Readmissions Reduction Program beyond the current and proposed conditions unless adequate guidelines exist for future conditions and the associated measures can be properly risk adjusted. Hospital readmissions for chronic illnesses are related to both pre-existing chronic conditions as well as to the education level and socioeconomic status of patients, all of which are major determinants of outcome. Outcomes for chronic illnesses can vary widely, resulting in potentially unfairly penalizing hospitals and physicians for readmissions that are not under their control. Another unintended consequence would be penalizing hospitals that care for the highest acuity Medicare patients and the potential that these hospitals will decrease their care for such patients, thereby creating an access issue. As such, these other drivers of readmission and mortality should be taken into consideration in the risk adjustment process. In addition, readmission measures should exclude readmissions for conditions that are unrelated to the original admission, such as “readmission” due to traumatic injury.”
Source: healthcaretechnologyonline.com

Video: How to select a Medicare Supplement or Medicare Advantage Plan

2014 Medicare Enrollment for Seniors Begins this Week

Medicare-trained counselors provide one-on-one counseling at the SBICs at the eight libraries listed below.  They can also tell seniors how to get help paying for medications and the difference between Original Medicare and Medicare Advantage.  Seniors who sign up for Medicare Advantage can cancel their enrollment next year between Jan. 1 and Feb. 14.
Source: theexaminernews.com

Medicare Beneficiaries: It’s that time of year to compare health plans for your best fit

AARP Vice President of Health and Family Nicole Duritz, explains “It is important for Medicare beneficiaries to know that during the open enrollment period you don’t have to do anything new. You certainly should not buy any new insurance coverage as a result of the Affordable Care Act. Your Medicare coverage satisfies the federal requirement that you have health insurance.”
Source: aarp.org

Who Can Issue Medicare Select Coverage?

Medicare Select is a managed health care system. If you have purchased a Medicare Select supplemental insurance policy, you have to use a hospital that is approved and on their list of approved health car providers. You can still use your own doctor but you have to use a hospital that is an approved provider of the Medicare Select program. The approved hospitals are local hospitals who have agreed to charge a designated sum as approved by the private insurance companies that underwrite private supplemental insurance to bridge the gap between Medicare and meeting qualifying deductibles, which means how much you have to pay before Medicare covers your health care.
Source: seniorcorps.org

Would all Medicare ACO beneficiaries please stand up?

A similar proposal was set forth by the Bipartisan Policy Center (BPC) in their April report, A Bipartisan Rx for Patient-Centered Care and System-wide Cost Containment. The joint report by Tom Daschle, Pete Domenici, Bill Frist and Alice M. Rivlin suggested the creation of Medicare Networks that allow enrolled beneficiaries to be guaranteed at least a $60 annual discount on their Medicare premiums for the first three years and adjusted in subsequent years. The proposal includes lower cost-sharing for services from providers within the network and higher cost-sharing for certain services outside of the network. When the Medicare Network meets quality goals and generates savings, some of the government’s share in the savings will be passed onto through reduced premiums for network enrollees. Unlike the existing Medicare ACO program, beneficiaries are given the freedom to decide if and what accountable care arrangement to enroll in and subsequently have personal responsibility to manage their care in a cost conscious way.
Source: projectmillennial.org

ibm medicare options: IBM Medicare www.extendhealth.com/ibm Confusion Abounds

I’ve been looking at some of the chatter about Medicare medigap and Medicare Advantage plans that has been posted other places.  Too often what people write is wrong.  Sadly, the Extend Health agents are also saying things that are wrong.  Double check everything to be sure you are getting an accurate description of Medicare rules and offerings and Extend Health rules.    For example, people are saying some doctors won’t accept medigap plans.  Doctors don’t chose to participate or not participate in medigap plans unless they are are “Medigap Select” plans.  There are only a couple of states that have those kinds of plans and even then “Select” plans are only available in a subset of state counties.  Everywhere else a doctor cannot say they don’t accept a medigap as Medicare automatically sends the claim to the medigap for processing.  The doctor can say they don’t want to wait for a medigap plan to pay them because the plan may be slow to pay.  The doctor might therefore ask for coinsurance payment up front.  You will then be reimbursed by the medigap for the coinsurance.  If you decide to get a medigap with a deductible you obviously have to pay the doctor coinsurance anyway until you reach the deductible amount for the policy.  Reminder – any coinsurance you pay will be reimbursed by Extend Health if you still have money left in your subsidy (I keep seeing postings where people are really confused about that). People also write about a lifetime cap for medigap reimbursements.  Maybe it applys to Select plans but regular medigaps are required to payout and can only cancel a client if the client stops paying medigap premiums.    I have seen people mix up medigaps and Medicare Advantage plans. Someone wrote about the vision and dental coverage provided by a medigap. Again, unless it was a “Select” plan – medigaps never offer vision and dental coverage but Medicare Advantage plans often do.  I have seen people write about how medigaps are age rated so the older you get the more expensive it will be.  IT DEPENDS ON YOUR STATE. I have seen people focus totally on the cost of Original Medicare + medigap+ part D versus a Medicare Advantage plan.  There is so much more to the decision of what insurance to have than the price tag of the plans you choose.  Reminder – if you need an expert doctor (say, for a second opinion) and they don’t accept your MA plan (but do accept Medicare) you will have to pay the total cost of the doctor visit out of your pocket if there is no money left in your HRA.  There is no way to factor that into a “cost” analysis.  
Source: blogspot.com

Will I Need to Change Doctors?

By pressing “Click Here And Get Your Quote ” above, (1) I consent to receive phone calls from TZ Insurance Solutions LLC or its affiliates, or one of its third-party partners, or their service provider partners on their behalf, regarding their products and services, at the phone number provided above, including my wireless number, if provided, and (2) I agree to this website’s privacy policy and terms and conditions. I understand that these calls may be generated using an automated technology. Partners may include SelectQuote, Health Plan One, Medicare Solutions and Allied Insurance.
Source: medicaresupplement.com

Obamacare vs. Medicare Part D

Posted by:  :  Category: Medicare

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The federal exchange system, meanwhile, was taken offline for repairs twice over the weekend, and again last night. The users who have already created accounts are also being told they have to reset their passwords. And even today, administration officials are still refusing to provide an estimate about when the system might be glitch-free. Health and Human Services Secretary Kathleen Sebelius claims she doesn’t even know how many people have signed up in the federal exchange system—even though California, Washington state, Maryland, New York, and Kentucky have all released application data. It’s not clear exactly what’s wrong with the federal exchange system, but it’s hard to trust the administration’s assurances that it has the problem under control. 
Source: reason.com

Video: Medicare Supplemental Insurance Comparison

Comparison of Medicare Premium Support Proposals

The brief compares the premium support provisions of these proposals, including how the level of premium support for beneficiaries would be determined; whether traditional Medicare would remain an option; what protections would be provided for low-income beneficiaries; and whether and how the proposals would cap federal spending on Medicare. These differences have important implications for Medicare beneficiaries, the federal budget, health care providers, and private health plans.
Source: kff.org

Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals

Many of the budget proposals and debt-reduction plans being considered by Congress and the Administration include proposals that would achieve substantial savings from the Medicare program over time. This brief features a side-by-side comparison of the key Medicare provisions in three major budget and debt-reduction plans:
Source: kff.org

New Market Intelligence Data Available on Medicare Quote Engine for Medicare Advantage

When you generate Medicare advantage comparisons for any county in the United States, in addition to being about to compare all of the premiums, deductibles and co-pays for 2 or more plans side by side, you will also now be able to see the enrollment statistics for each plan.  You can sort the plans based on highest or lowest enrollment.  In addition to the enrollment numbers, we indicate whether the monthly enrollment is increasing, decreasing or remaining stable.
Source: ritterim.com

Medicare Benefits and Cost

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

Medicare Part D Beneficiaries Not Enrolled in Lowest Cost Drug Plan

Medicare prescription drug coverage, also known as Medicare Part D, provide beneficiaries with coverage for eligible prescription medications they need. This coverage comes with a variety of costs, including monthly premiums and out-of-pocket costs  (copayments, coinsurance, and deductibles). According to a recent study by eHealth, out of all the people who used eHealth’s comparison tools to compare prices in stand-alone Medicare Prescription Drug Plans (PDPs), only 6% were in the PDP with the lowest total out-of-pocket costs available to them.
Source: ehealthmedicare.com

HealthLandscape: New GIS Visualization: The Inpatient Hospital Costs Explorer

The IP Hospital Costs Explorer combines two data sets: Medicare Provider Charge Data (Inpatient), which was just released in May, and Hospital Compare Patient Survey Data (from Medicare.gov). Patients, their families and caregivers, and clinicians can use the Explorer to make an informed decision about which hospital may provide the best care experience. Users begin by choosing a geographic area. (The version shown has selected indicators for Ohio, Kentucky, and Indiana.) A green circle indicates hospitals with low costs, yellow indicates hospitals with moderate costs, and red indicates hospitals with high costs.
Source: blogspot.com

Comparing Medicare Traditional to Medicare Advantage: Outcomes, Visits, Case Weight, and HHCAHPS

SHP reports on four metrics from its database for the calendar year 2012, showing a side-by-side comparison of Medicare Traditional to Medicare Advantage. Take a look at the data, particularly the difference in length of stay (LOS) but with little impact on quality metrics.
Source: shpdata.com

Medicare supplemental insurance Insurance Comparison

There are several agencies that include medical care insurance.? These contractors have several packages there for match those that have the correct insurance cover. Finding a good health policy could be a complicated job.? You have got to be sure that the protection you obtain is good for a price you can affordably pay.? For that reason, this is a good plan to assemble insurance quotes online for the greatest options widely available to you personally.
Source: insuranceshealthy.com

Retiree with No Technology Background Launches Medicare Supplemental Insurance Comparison Site

(PRBuzz.com) June 26, 2013 — Here’s how plans for retirement used to go for most – work at the same job for several decades, build up social security and pension income, retire at 65 and dedicate time to improving canasta or golf skills. Maybe some people had other ideas, but suffice it to say, people view retirement much differently today than they did 20 years ago. Retired firefighter, Steven Pewter is a perfect example of this. At age 74, with absolutely no technology background, Pewter used a laptop computer he got as a birthday present to build a website for seniors to compare Medicare supplemental insurance plans, MedicareSupplementalInsuranceComparison.net. Pewter’s story supports the findings of a new survey from Del Webb – a leading builder of active-adult communities. It showed that almost 80 percent of boomers expect to work in some capacity, even after they retire, and not just for money. In fact, the majority, fifty-one percent, plan to work to avoid boredom and maintain a sense of purpose. “I come from working stock,” commented Pewter when asked about his motivation. “I certainly wasn’t going to just sit around and slowly fade to dust after retirement.” Pewter was driven to create the Medicare supplemental insurance comparison site after a frustrating personal experience shopping for supplemental coverage online. Hours and hours of research turned up only sites that required significant personal information before returning any valuable information on plans or rates. So, he decided to use his new computer skills to create a site that would give people detailed supplemental insurance coverage and rate information after entering just their zip code. The site gained almost instant popularity with 10,000 visits in the first week. By the end of the first month, 30,000 people had used the site to research Medicare supplemental insurance. And now nearly seven months later, the site continues to attract seniors, not just with its rate and plan comparison info, but with the dozens of articles, tutorials and how-to pieces it features that are updated regularly. Pewter’s family members comment that he has approached his new Internet endeavor with the gusto and enthusiasm of a man a third his age. “Well, it’s my kids and grandkids that keep me young,” Pewter said. “Knowing they’re so proud of what I accomplished with the site pushes me to keep at it.” About MedicareSupplementalInsuranceComparison.net MedicareSupplementalInsuranceComparison.net is a site for seniors to compare rate plan and coverage information for Medicare supplemental insurance. By entering just a zip code, visitors can retrieve detailed results from leading insurance providers in their area. And, the site is constantly updated with helpful articles and tutorials to guide people through the sometimes confusing world of Medicare. For more information, visit: www.medicaresupplementalinsurancecomparison.net ###  Company: MedicareSupplementalInsuranceComparison Contact: Steven Pewter Phone: 303 555-0181 Email: admin[@]rocketfactor.com
Source: prbuzz.com

Comparison Friction: Experimental Evidence from Medicare Drug Plans

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28 percent in the intervention group, versus 17 percent in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 per year among letter recipients—roughly 5 percent of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice.
Source: nber.org

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October 14, 2013

Bill Boosts Telehealth Use for Medicare Providers

Posted by:  :  Category: Medicare

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The Massachusetts eHealth Collaborative (MAeHC) has announced that its Quality Data Center (QDC) v. 3.0 electronic health record (EHR) is certified to support meaningful use Stages 1 and 2 by the Certification Commission for Health Information Technology (CCHIT) and is compliant with the 2014 Office of the National Coordinator for Health Information Technology HIT criteria. According to MaeHC, it is one of the first to receive certification for all three criteria approved by the Secretary of Health and Human Services for eligible providers or hospital technology.
Source: healthcare-informatics.com

Video: The Medicare Learning Network (MLN)_ Official CMS Information for Fee-For-Service Providers

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

Smart Card Proposal Looks to Reduce Medicare Fraud

Under this proposal, no external information would be printed on the card (like Medicare numbers are today). Instead, a user’s data would be housed on an internal data chip. Card readers would be installed at participating areas for all services, and a beneficiary would swipe their card in order to receive any Medicare-related amenity. This would create an electronic record of the transaction, which would then allow for easier monitoring and investigation into any alleged instances of Medicare fraud.
Source: ehealthmedicare.com

Now is the Time to Review 2014 Medicare Options

Pictured is Marguerite Stewart, Union County SHIP (State Health Insurance Assistance Program) volunteer counselor at SAGE Eldercare, providing Medicare-related advice to a client.  A program on changes to 2014 Medicare will be held on November 20 from 12:30 pm to 2:30 pm at SAGE; additionally counselors will be available to help beneficiaries with plan selections.  For 2014 options, the Medicare Open Enrollment is from October 15 to December 7, 2013.  SAGE Eldercare SHIP counselors are taking appointments now to assist area older adults in Union County with their Medicare-related options.  For more information, call 908.273.6999 or email ship@sageeldercare.org.  If you live outside Union County, visit www.medicare.gov/contacts or call 1‑800‑MEDICARE to get the phone numbers of SHIP representatives in other NJ counties or in other U.S. states.  Information on SAGE Eldercare can be found at www.sageeldercare.org.
Source: thealternativepress.com

Tips on Reducing Prescription Drug Costs for Medicare Patients

According to reports, Medicare’s website allows shoppers to compare estimated out-of-pocket expenses for various drug plans. Savvy consumers can enter their medications and compare the actual cost of each plan. This could help reduce your medical debt, which could help you avoid Chapter 7 bankruptcy.
Source: clearbankruptcy.com

Medicare Secondary Payer: Web Portal to Collect Data on Conditional Payment Amounts and Claims Detail 

Within 30 days of securing a settlement, the beneficiary or his or her attorney or other representative must submit information specified by the settlement.  CMS says that the settlement information will be the same information that the Medicare agency typically collects to calculate its final demand amount.  The information includes the date of the settlement, the total settlement amount, the attorney fee amount or percentage, and additional costs borne by the beneficiary to obtain his or her settlement.[11]  If the beneficiary does not submit the settlement information within the 30 day period above, the final conditional payment amount obtained through the web portal will expire.[12]  The web portal will also have the capacity for beneficiaries to request a "claims refresh." That refresh will be initiated no later than 5 business days after the electronic request is initiated.
Source: medicareadvocacy.org

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October 14, 2013

Slalom Tableau Showdown delivers key Medicare insights to Provider CIOs

Posted by:  :  Category: Medicare

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From John Mathis, first-place winner: Visualizing Medicare data revealed several interesting financial aspects of our healthcare system. By viewing the state and classification heat map, it is apparent that California, Nevada, and New Jersey have the highest average costs. It is especially odd for New Jersey given its proximity to Maryland, which has the lowest state costs. Also interesting is the scatter plot of Diagnosis Related Group (DRG) codes, which reveals several outliers in terms of cost and patient volume. Public health administrators looking to bring down costs could use this visualization to identify procedures with the highest costs and frequency that would most benefit from efficiency improvements.
Source: slalom.com

Video: Phone Number Medicare Providers Medical Mobility Devices Spinal Cord Injury Around Greensboro

Caution: Home Health Episode Payment Caps  

While there is no limit on the number of episodes of care Medicare will cover for an individual, the national average number of covered episodes per user of HH services is 2.0 (approximately 4 months of HH services at a time).[4]  Even so, the Medicare Payment Advisory Commission (MedPAC) has identified a few geographic areas of "high utilization"of HH services (25 counties in 5 states: Florida, Louisiana, Mississippi, Oklahoma, and Texas).[5] In these areas, episodes per user average as high as 4.6[6] (compared to the national average of 2).   According to MedPAC, this concentration of high utilization in a few areas has "raised concerns that some of this utilization may be due to fraud and abuse." These high utilization areas also see a significant increase in the total number of new, primarily for-profit HH agencies, further supporting the suggestion that fraud and abuse are a concern.[7]
Source: medicareadvocacy.org

CMS identifies ‘large number of overpayments’ for incarcerated Medicare beneficiaries

If a beneficiary did not inform the SSA of his or her release from custody, this may result in his or her record being incorrect. If a provider believes this is the case, the provider may wish to encourage the beneficiary to contact his or her local SSA office to have his or her records updated. It can take up to one month for the beneficiary’s Medicare eligibility file to be updated with the revised SSA information. If the beneficiary tells the provider that SSA is updating his or her records, we suggest the provider contact the Medicare Administrative Contractor using the contact information on the overpayment demand letter.
Source: hmenews.com

BREAKING NEWS: CMS Releases Spending Numbers: Medicare Spending Slows Considerably

> “Physician and clinical services spending has remained low compared to previous years. Spending on physician and clinical services is estimated to have grown 4.6 percent in 2012, compared to 4.3 percent in 2011. The Actuary’s office projects that physician and clinical services spending will rise to 7.1 percent in 2014, when more Americans will have health insurance and utilizae physician services. These projections do not take into account Medicare physician payment cuts under the Sustainable Rate formula, which—if not overridden by Congress—would restrain growth in spending for physicians’ services to 4.7 percent.”
Source: healthcare-informatics.com

SNF Medicare Part A appeals increase, success rate holds steady: OIG report

SNFs filed about 8,900 redeterminations in 2008, compared with about 11,300 in 2012, representing a 27% increase. The Department of Health and Human Services Office of Inspector General derived these figures from an analysis of a government database, and released the numbers in the report “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness.”
Source: mcknights.com

Medicare Health Professional News

Using the Healthcare Identifiers (HI) Service, update personal or organisation information, manage links with other service providers, search for Healthcare Provider Identifier—Individual (HPI–I) numbers and Healthcare Provider Identifier—Organisation (HPI–O) numbers, and check provider status.
Source: gov.au

Providers Face Growing Demands From Increasing Number of Medicare Contractors

First there is the general category of claims processing contractors, now mainly known as “Medicare administrative contractors” (MACs) but also referred to, still, in statutes, laws and judicial decisions, as fiscal intermediaries or carriers. MACs are involved in the first level of appeals and may contact providers for a variety of reasons, including the resolution of issues regarding initial and renewal enrollment applications; providing education and guidance on procedures for billing Medicare; resolving issues regarding claims; requesting medical records related to claims that have been submitted so the MAC can perform a medical review; paying providers for approved claims or explaining why some claims are not processed or are denied; and recovering overpayments on claims previously processed. CMS uses Qualified Independent Contractors to conduct reconsiderations, the second level of appeals.
Source: wolterskluwerlb.com

Smart Card Proposal Looks to Reduce Medicare Fraud

Under this proposal, no external information would be printed on the card (like Medicare numbers are today). Instead, a user’s data would be housed on an internal data chip. Card readers would be installed at participating areas for all services, and a beneficiary would swipe their card in order to receive any Medicare-related amenity. This would create an electronic record of the transaction, which would then allow for easier monitoring and investigation into any alleged instances of Medicare fraud.
Source: ehealthmedicare.com

Words Matter: Defining Hospital Costs, Payments and Charges – And The Numbers That Matter Most to Consumers

Neither the government nor, in most instances, private insurers actually pay a hospital’s full charges.  Even patients not covered by Medicare, Medicaid or private insurance are almost never expected to pay full charges.  Hospitals have generous discount payment policies for uninsured or underinsured patients which limit how much these patients ultimately will be expected to pay out of pocket.  Typically, that payment amount is no more than the amount a private insurer would pay for the same service. In other words, uninsured patients are only very infrequently expected to pay “charges”; instead, they receive discounts similar to what the hospital negotiates with private insurance plans or the Medicare rate.
Source: fahpolicy.org

Feds ban some Medicare providers in crackdown

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

Are Doctors Really Accepting More Medicare Patients?

Physicians may opt out of the Medicare program for two years and establish written contracts with Medicare beneficiaries. Under these private contracts, beneficiaries are liable for payment of the care furnished. If a Medicare beneficiary receives services from a physician who has ‘opted out’, the beneficiary can pay the physician directly, but neither the physician nor the beneficiary receives any payment from Medicare. A 2005 study examining characteristics of providers opting out of Medicare found that overall less than one percent of providers eligible to opt out of Medicare did so, and the two specialties with the highest opt out percentages were psychiatrists (with 1.11% opting out) and plastic and reconstructive surgeons (with 1.56% opting out). In contrast, about a third of one percent of primary care physicians (0.35%) opted out of Medicare.
Source: mintpressnews.com

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October 14, 2013

CMS: Medicare open enrollment begins Oct. 15 as planned

Posted by:  :  Category: Medicare

Beneficiaries can use this Medicare Annual Election Period to explore various Medicare plans, compare costs and options, and check whether providers or institutions accept certain plans. For example, those taking new medications, who relocate, are diagnosed with a chronic medical condition, or experience an accident or injury which changes their health status may want to add or drop certain benefits, or find a plan with lower co-pays. A move to a different state may require finding new physicians or joining a plan with different participating facilities in their new coverage area. Even if a person’s status remains the same, plans can change — benefits might be added or dropped, or prescription medications might go on or off formulary.
Source: healthjournalism.org

Video: Dave Hamilton Medicare Advantage Open Enrollment” Retirement Planner Jeff Vogan Mesa Tucson Arizona

Medicare Online Enrollment

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 Medicare Anthem Medigap 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 Connecticut 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 2013 Wellcare medicare
Source: croweandassociates.com

Austin Medicare Workshop Helps With Enrollment

The program was to be entirely self-financed with the premiums participants paid. Obama officials said that presented them with a problem: If they designed a benefits package generous enough to meet the law’s requirements, they would have had to set premiums so high that few healthy people would enroll. And without a large share of healthy people in the pool, the CLASS plan would have become even more expensive, forcing the government to raise premiums even higher, to the point of the program’s collapse.
Source: kut.org

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Source: kffb.com

Marshall Elder and Estate Planning Blog: It’s Medicare Open Enrollment Period

Once on the website you can find and compare the plans that are available in your region. Plug in your basic information including the prescription drugs you expect to be taking in 2014. The plan finder will then provide you with a list of stand-alone Part D drug plans (for those with traditional Medicare) and Medicare Advantage plans that are available to you. The list will include the monthly premium, your estimated total annual drug costs and other valuable information.
Source: blogspot.com

2014 Medicare Enrollment for Seniors Begins this Week

Medicare-trained counselors provide one-on-one counseling at the SBICs at the eight libraries listed below.  They can also tell seniors how to get help paying for medications and the difference between Original Medicare and Medicare Advantage.  Seniors who sign up for Medicare Advantage can cancel their enrollment next year between Jan. 1 and Feb. 14.
Source: theexaminernews.com

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for millions of Medicare beneficiaries begins Oct. 15. In that time, seniors can shop for a private health plan known as Medicare Advantage, pick a drug insurance policy or buy a supplemental Medigap plan. And in nearly two dozen states, some Medicare beneficiaries who also qualify for Medicaid may be choosing private managed care plans. None of these four kinds of coverage will be offered in the health law’s marketplaces.
Source: kaiserhealthnews.org

Local Conservative Media Jump The Gun To Attack Exchange Rollout

Even though there were problems this week, marketplace websites were at least up and running on the promised day, October 1.  As reported by HHS officials, there were nearly 5 million visitors to healthcare.gov on the first day, far more than have ever visited Medicare.gov.  During the 2005 signup period for Medicare Part D, the number of daily visitors to the online Plan Finder peaked at about 160,000 for a program that would enroll more people than are expected to enroll under the Affordable Care Act.  By this standard, the level of interest in getting online information from the marketplaces is remarkable.
Source: mediamatters.org

GoHealth Gets Consumers Ready for Medicare Open Enrollment

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Source: 88finance.com

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October 14, 2013

Blue Medicare Regional PPO Plan

Posted by:  :  Category: Medicare

With so many different providers, it’s often a challenge to find Medicare providers you can truly trust. It’s tough to know which companies are reliable and which are not. Florida seniors overwhelmingly choose Florida Blue as their Medicare provider and the Blue Medicare plans have earned a reputation as a dependable, top of the line option. Florida Blue has earned a solid reputation built on generations of happy, satisfied customers. With a Blue Medicare health plan, you’re getting more than a piece of paper, but a promise that when you need health care, you can get it- no questions asked.
Source: mioti.com

Video: Is Freedom Blue PPO a Medicare Supplement?

Florida Blue Medicare PPO

Prescription drugs are a significant part of staying healthy and it’s critical you can get the medicine you need to look and feel your best. With Florida Blue Medicare PPO, generic and brand name drugs are covered with a $0 deductible for generic drugs and $6 drug co-pay. Plus, if you choose to have your medication mailed to you, the co-pay is $0. With Florida Blue Medicare PPO, access to the right medication is easier than ever before.
Source: comhealth.org

Blue Medicare Regional PPO Plan

Cost is a major concern for most of us these days and hardly anyone passes on the chance to save a few dollars. With a Blue Medicare Regional PPO plan, saving is easy. With $0 monthly plan premiums, moderate out-of-pocket expenses and more, it’s easy to find the perfect plan to fit your needs and your wallet. That’s great news for seniors on a fixed income and exactly why so many Floridians choose Florida Blue as their Medicare health plan option. Plus, with no deductible for preventive care, you can get vaccines, routine screenings and more easily and conveniently.
Source: ruthiehendricks.com

New medical plans for faculty, staff for 2013 / UCLA Today

Some big changes and new choices in medical plans are coming to Open Enrollment this fall. UC is offering a revamped menu of plans for 2014 that offers better value and clearer choices, including two new plans: Blue Shield Health Savings Plan, which features a UC-funded health savings account; and UC Care, UC’s own three-tier PPO plan that offers members access to UC doctors and hospitals as well as the Blue Shield PPO network. Health Net Blue & Gold, Kaiser Permanente, Western Health Advantage and Core (administered by Blue Shield) will still be available. Four plans — Anthem Blue Cross PPO and PLUS, Anthem Lumenos with HRA and Health Net Full HMO — are being discontinued.   “The 2014 plans provide clear and distinct choices to meet our employees and retirees’ diverse and changing needs,” said Michael Baptista, executive director of benefits programs and strategy. “The designs of these plans have very little overlap. Everyone can choose a plan based on what’s most important to him or her, whether that’s having predictable costs or the widest choice of doctors.” UC employees and retirees will continue to have a broad choice of providers — including UC medical center doctors, hospitals and medical groups — and plan designs to fit their needs. The provider networks for both the Blue Shield Health Savings Plan and UC Care include 97 percent of the providers in the current Anthem Blue Cross network, so most people in those discontinued plans should be able to keep their doctor. Employees currently in Anthem Blue Cross PPO, Anthem Blue Cross PLUS and Health Net HMO will also pay smaller monthly premiums next year, regardless of the new plan they choose. Savings will depend on the new plan, salary band and dependents covered. The Blue Shield Health Savings Plan premiums are expected to be similar to the premiums for Anthem Lumenos PPO with HRA. Premiums for Health Net Blue & Gold, Kaiser and WHA are expected to increase from $2 to $10 per month, depending on the plan, salary band and dependents covered. UC will continue to cover an average of about 85 percent of the cost of the premiums. The final premiums will be available in early October. The 2014 plan offerings are the result of a comprehensive review of UC’s medical plan portfolio aimed at providing high quality medical insurance that is more specific to individual needs, while limiting cost increases to employees and the university. The review also offered an opportunity to leverage UC’s outstanding medical centers and take advantage of the changing medical-insurance marketplace. “We know how important quality medical insurance is to our employees and retirees, and we are continually looking for ways to ensure good benefits while limiting cost increases for employees and the university,” said Baptista. “Health care reform and a changing medical-insurance marketplace provided a good opportunity to rethink our benefits while still maintaining choice and quality.” Two Plans In, Four Plans Out The two new plans offer broad, nationwide networks of doctors and hospitals through Blue Shield, including UC’s medical centers, and both are expected to have lower monthly premiums than Anthem Blue Cross PPO, Anthem Blue Cross PLUS and Health Net HMO. UC Care is a new health plan created just for UC employees, retirees and families with coverage wherever you live, worldwide. You can get care from UC doctors and medical centers as well as the entire Blue Shield network of providers. You pay a fixed copayment when you use UC and other select providers near all UC campuses and coinsurance when using the other 65,000 Blue Shield providers. You also have coverage for out-of-network care. The Blue Shield Health Savings Plan is a high-deductible PPO plan paired with a health savings account (HSA) that lets you pay your out-of-pocket health care costs with tax-free dollars. UC provides an initial contribution and you can also make pre-tax contributions. You can use the funds any time for qualified medical expenses or save them for future health care needs. Your HSA balance carries over from year-to-year and you own the balance in the account, even if you transfer to another medical plan or leave UC. Blue Shield’s large PPO provider network offers a wide choice of doctors and hospitals or you can see out-of-network providers if you want to pay more. UC is eliminating the Anthem Blue Cross PPO and PLUS plans and the Health Net full HMO plan because they no longer provide the right value. “The costs for these plans continue to increase at a much faster rate than the other plans,” Baptista said. “Neither the university nor employees can continue to absorb double-digit annual increases.” The Anthem Lumenos PPO with HRA is being replaced with the Blue Shield Health Savings Plan. Employees are finding plans with health savings accounts to be more popular because of the tax advantages, the portability of the account and the ability to use the account to save for future retirement insurance needs. New for retirees Retirees and employees planning to retire in 2014 will have similar choices as employees. All six employee plans will be available to retirees not yet eligible for Medicare. Medicare-eligible retirees in California will have five plan options: Kaiser Senior Advantage, Health Net Seniority Plus, Blue Shield PPO, Blue Shield PPO without prescription drug coverage and Blue Shield High Option Supplement to Medicare. The Blue Shield Medicare plans are very similar to the current Anthem Blue Cross Medicare plans. For Medicare-eligible retirees living outside California, UC is taking a new approach. For those Medicare-eligible retirees with all covered family members in Medicare, UC will fund a Health Reimbursement Arrangement (HRA) which retirees will use to purchase individual coverage through Extend Health, a company that sponsors a Medicare Exchange. With the assistance of Extend Health’s licensed and trained benefit advisors, each covered family member will choose an individual Medicare plan that’s best for them. That includes Kaiser and other Medicare Advantage plans available in the retiree’s location. With the growing market for individual plans, many retirees will have more choices, many of which could meet their needs better than the UC plans currently available. In 2014, due to other changes in the UC-sponsored medical plan portfolio, only the Medicare PPO and the High Option Supplement to Medicare plans would have been available to those outside of California. UC plans extensive communication and education about medical plan choices throughout the fall to help faculty, staff and retirees make good choices. Watch for additional news stories, in-home mailings and campus events where you can learn more. Find all the details here.
Source: ucla.edu

PPO vs. EPO for My Daughter?

Question: I live in Santa Cruz and currently have double insurance. Medicare(disability) and Blue Shield Stand-Alone PPO SMall Group. I needed to keep the PPO because I have a minor daughter and Medicare does not cover minors. I noticed that Blue Shield will only have an EPO. My daughter will be going off to college next year. What is the difference between an EPO and PPO? I want to be able to select my own drs. I do not know where my daughter will be going to college but it will be in CA. Should I consider getting her a separate plan ? What plan would you recommend for me? Will the small group business plans continue under Blue Shield?
Source: cahba.com

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

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October 14, 2013

How Health Plan Risk Adjustment Models May Change Under the ACA

Posted by:  :  Category: Medicare

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Measuring expected health costs is often tricky, and some patients end up costing health plans far more than what they pay in premiums. Insurers also have to tussle with adverse selection, which happens when the sickest people buy insurance and the healthy stay away – driving up health costs and destabilizing the risk pool upon which premiums and ultimately the insurance model are based.  As a result, some health plans in the past have tried to limit the chance that costs will exceed premium revenues by encouraging healthier people to enroll (“cherry pick”) and by discouraging potentially costly enrollees (“lemon drop”).  However, the ACA regulatory framework – which includes guaranteed issue, adjustment community rating, mandatory coverage of pre-existing conditions, and no annual or lifetime limits – changes things completely.
Source: thehealthcareblog.com

Video: Introduction to Medicaid – Risk Adjustment Using CDPS

MRA Alerts and Updates: Innovate your Medicare Risk Adjustment Program

In an era of accelerating medical costs and flat payments from CMS, accurately reflecting the health status of your members through proper HCC (Hierarchical Condition Category) management is the only way for your Medicare Advantage plan to remain financially viable.  The secret to successful long-term risk adjustment for your Medicare Advantage plan is to properly educate your providers as to the value of complete and accurate coding of every member, every year. Historically, providers have coded for payment, which simply doesn’t work well in the new world of 100 percent risk-based plan compensation, where complete and accurate coding of every patient on an annual basis is imperative.
Source: blogspot.com

Medicare Risk Adjustment As Well As , Medical Coding Re

Indian economy is positively on a grow in the global map. None wonder most off the industries in the nation end up being doing well. The same flows to the insurance sector. In the past, good health insurance was far from given much weight by people. They thought that insurance is practically nothing but a high end vehicles tool for currently the rich. Today, the trend comes armed with been reversed. People are buying insurance policies which can enjoy health is comprised of for themselves in addition , their families. They have came to the realization the importance regarding various types concerning insurance options sort of as group health insurance and medicare supplement.
Source: svrrmasjon.net

Outsource Strategies International: Medicare Risk Adjustment Coding

Medicare risk adjustment coding (MRA Coding) is a method of adjusting capitation payments to health plans, which can be higher or lower, to measure the changes in the expected health cost of individuals. The risk adjustment coding calculates the risk score for each Medicare Advantage (MA) plan enrollee based on health status and geographical factors. MRA coding has become vital in all healthcare organizations, hospitals, individual practices and for physicians to get appropriate reimbursements from Medicare. Healthcare entities that lack the required proficiency in coding are likely to face delays and denials on account of erratic coding for Medicare. Outsourcing the risk adjustment coding tasks to a reliable medical billing company is the practical option.
Source: blogspot.com

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

Risk adjustment is important to ensure that payments to MA plans adequately account for differences in beneficiaries’ health status and to maintain plans’ financial incentive to enroll and care for beneficiaries regardless of their health status. Our work confirms that differences in diagnostic coding caused risk scores for MA beneficiaries to be higher than those for comparable beneficiaries in Medicare FFS in 2010, 2011, and 2012. CMS’s decision to use a 3.4 percent adjustment to risk scores for 2010 through 2012 instead of the higher adjustments called for by our analysis resulted in excess payments to MA plans. The existence of such excess payments indicates that CMS’s adjustment does not accurately account for differences in treatment and diagnostic coding between MA plans and Medicare FFS—the stated goal of the statute that required CMS to develop a diagnostic coding adjustment. In our January 2012 report, we recommended that CMS take steps to improve the accuracy of the adjustment to account for excess payments due to differences in diagnostic coding. We noted that CMS could, for example, account for additional beneficiary characteristics, include the most recent data available, identify and account for all the years of coding differences that could affect the payment year for which an adjustment is made, and incorporate the trend of the impact of coding differences on risk scores. CMS’s adjustment for 2013 is the same as it used in 2010, 2011, and 2012. However, given our finding that this adjustment was too low and resulted in estimated excess payments to MA plans of at least $3.2 billion, we continue to believe that it is important for CMS to implement our recommendation that it update its methodology to more accurately account for differences in diagnostic coding.
Source: pnhp.org

Study Finds Bias in Medicare’s Risk

A new study from the Dartmouth Atlas Project challenges the effectiveness of Medicare’s risk-adjustment efforts, or the formulas commonly used to assess how sick patients are. Medicare uses risk adjustment in its payment methodology to base reimbursement on the underlying health status of a hospital’s patients in an effort to protect hospitals with the sickest patients from losing money. For this study, published in the journal BMJ, Dartmouth researchers analyzed Medicare claims for services provided in 2007 among 306 hospital referral regions. They analyzed three different formulas that are commonly used to assess how sick patients are. Each formula is based on the number and nature of diagnoses as well patient age, race and sex. Researchers also analyzed the death rates of patient populations in each of the 306 regions. They found the mean number of physician visits per patient during the last six months of life varied from 10 to 59 and was not correlated with age, sex and race-adjusted mortality. Rather, the researchers found the rate of visits was strongly correlated with the number of diagnoses observed in the claims data. The authors concluded that “the more one looks, the more one finds.” This means that the sicker regions do not necessarily have higher patient visit rates. It also suggests that using diagnoses data to adjust for risk produces problems such as (a) bias in research and evaluation, (b) biased performance measures and (c) biased payment to third-party payors, according to the study. Bias in research and evaluation. If spending or utilization per capita and rates of diagnosis are highly correlated, studies seeking to evaluate the relationship between patient visits and mortality while controlling for illnesses will be skewed. Biased performance measures. “Adjusting performance measures using several different diagnoses makes providers who frequently make diagnoses look better than those who manage their patients more conservatively,” the study authors concluded. Biased payment to third-party payors. Payments to third-party payors that are adjusted based on the frequency of diagnoses recorded in a administrative database could result in higher per-capita payments in regions that have more physicians, hospital beds and visits per capita — regardless of the underlying disease burden among patients.
Source: beckershospitalreview.com

Medicare Risk Adjustment As Medical Coding Rehearsing

Some sort of medicare supplement leads offer you assistance in days past when Medicare stops. It is very important recognize about such brings us and learn how to get good Medigap lead programs fitting your need. By buying similar leads you may very well insure all scientific expenses that these Medicare fails to assist you cover, and the same thing without any new financial expense. The series of regulatory actions, CMS recently been targeting diagnostic image arrangements. Diagnostic imaging providers also suppliers should feel attentive to improvements with future rulemakings, which may very much affect the structure of many already present imaging arrangements. As a result, we advise carriers to incorporate accessories into their prevailing contractual arrangements which will allow these arrangements in order to a more strict regulatory framework. Finally, the regulating changes discussed in this article likely will never be CMS’s final word on diagnostic imaging. Providers should be mindful of the before entering hooked on structures that cannot be unwound or revised. Previously you can pick up any of these supplies, you need to get some sort of prescription from your entire physician. This is only exclusive for people considering diabetes and those individuals who qualify in support of what are medicare supplement plans Part B, so your health care worker needs to certify that you are often suffering from all the said condition. The prescription may also include the details such as this particular frequency of a blood sugar test, the number related to supplies you ought every month, many medical equipment an individual need and regardless of whether you are insulin or definitely. These unquestionably are very important for the reason Medicare wants which will make sure that experts claim you are getting everything you need to get for your difficulty and that anybody really have all forms of. A great person covered while under FCPA who avoids the knowledge where it an intermediary so much as a provider ahs paid and it could be will pay some bribe to a meaningful non-U.S. official is client to the one kind of justice as a company that avoids ability of employees that will make those reimbursements and promises. Figuring out which program ideal for suited for some participant’s unique needs can be this challenge, as techniques various options along with some plans, however, not with others. Therefore, participants use the services of prepare advisor to all of them navigate through the Medicare Supplement function and menu off choices. Having the right information is critical to ensuring this participants are enrolled in a medigap program that will furthermore ensure they get the best healthcare coverage for their good health profiles, but simultaneously for their financial situations. Treatment Advantage Plans probably are health plan options (like an The hmo or PPO) which usually are approved by Medicare, and offered simply private companies. These plans are typically part of Medicare, and are some times called Part C or MA Courses. As being a to pursue a new various levels coming from all appeal, certain designs must be have been aquainted with a certain steps in the appeal process. Although many providers carry not seen much success at most of the redetermination stage attached to the appeal, most of the later stages of appeal, particularly often the ALJ stage, will likely prove more efficient. Providers must use as a result of care in complying with the timeframes and other requirements set forth for the appeals whole process. Failure to do so may result about the inability when you need to pursue the selling point.
Source: skyrock.com

The Medicare Annual Wellness Visit: A Key to Better Patient Care

The AWV is not a yearly physical exam. The purpose of the visit is to deliver evidence-based preventive services by an appropriate clinical provider in the appropriate clinical setting. It is also mandatory to provide a Health Risk Assessment (HRA) as part of the visit. The HRA identifies the high-risk over-utilizer; CMS uses the CMS-HCC risk methodology. The use of HCC scoring may be of benefit in designing care plans, particularly in planning for post-discharge care. Given that patients with higher HCC scores and therefore a greater number of medical complications have significantly higher post-discharge costs, it may be useful for the clinical care team to carefully review all of the diagnoses for all patients to identify those patients having medical conditions that may create significant post-discharge costs. The AWV HRA is an opportune time to collect the ICD-9 codes necessary for CMS-HCC risk adjusting methodology. There are software applications that automate this process in a prospective fashion.
Source: physicianspractice.com

Press Release: Medicare Compliance & Technology Webinar

 webinar through their partnership with America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance industry. The topic will be Improving Medicare Compliance Effectiveness through Technology. This will be the fourth in the series of free seminars and roundtables created exclusively for AHIP members and will be focused on compliance for health insurance plans that offer Medicare Advantage and Prescription Drug Plans. Hoverstate will explore the trends in corrective actions related to non-compliance and how health plans can navigate through circumstances made even more complex due to new Medicare and Medicaid product regulations.
Source: hoverstate.com

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October 14, 2013

Obamacare vs. Medicare Part D

Posted by:  :  Category: Medicare

The federal exchange system, meanwhile, was taken offline for repairs twice over the weekend, and again last night. The users who have already created accounts are also being told they have to reset their passwords. And even today, administration officials are still refusing to provide an estimate about when the system might be glitch-free. Health and Human Services Secretary Kathleen Sebelius claims she doesn’t even know how many people have signed up in the federal exchange system—even though California, Washington state, Maryland, New York, and Kentucky have all released application data. It’s not clear exactly what’s wrong with the federal exchange system, but it’s hard to trust the administration’s assurances that it has the problem under control. 
Source: reason.com

Video: How to Apply For Medicaid in Florida Online

Federal Shutdown: What’s Closed And What’s Open?

WHAT CLOSES: * Any federal agency that’s subject to appropriations. Each agency has the discretion to decide who is “excepted” or “emergency”, and who is furloughed. * All National Parks * All federally-funded museums, including Smithsonian and the National Zoo. * All federal government websites * Research by Health and Human Services stops. So does the grant process. Depending on how long it lasts, that will also impact medical research at hospitals and universities. * Applying for Social Security. If you’re a new retiree, your application won’t be processed. * IRS walk-in centers. Your paper tax return will not be processed. * Loan applications for small businesses, college tuition, or mortgages. * All Library of Congress buildings. All public events will be cancelled and web sites will be inaccessible. * Federal contractors will be out of work. * Federal workers (except “excepted” or “emergency” personnel) will not be allowed to work, not even from home. No blackberry, no smartphone, no laptop. Not even allowed to check work email.
Source: cbslocal.com

2014 Medicare Enrollment for Seniors Begins this Week

Medicare-trained counselors provide one-on-one counseling at the SBICs at the eight libraries listed below.  They can also tell seniors how to get help paying for medications and the difference between Original Medicare and Medicare Advantage.  Seniors who sign up for Medicare Advantage can cancel their enrollment next year between Jan. 1 and Feb. 14.
Source: theexaminernews.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

Medicare Supplemental Insurance Open Enrollment Period

Fortunately, you can purchase a Medigap insurance policy to make up the difference for these types of expenses. After Medicare pays its share for covered medical care, the remaining claim is automatically forwarded to a Medigap policy. The provider of these Medicare supplements then pays the balance or a portion of the balance.
Source: stevendejoode.com

ACOs Multiply As Medicare Announces 27 New Ones

Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh, says ACOs will continue to be the model of the future, even if the Supreme Court strikes down the health care law. The private sector, he says, has been moving in the direction of coordinated care for years.
Source: kaiserhealthnews.org

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October 14, 2013

UniCare MedicareRx Rewards Part D

Posted by:  :  Category: Medicare

Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Washington D.C., West Virginia and Wyoming.
Source: affordablemedicareplan.com

Video: Unicare Medicare Advantage Plans – Compare to 180+ Companie

UNI/CARE Connects Medical Records to Microsoft Dynamics CRM 2011

Microsoft is committed to improving health around the world through software innovation. Over the past 13 years, Microsoft has steadily increased its investments in health with a focus on addressing the challenges of health providers, health and social services organizations, payers, consumers and life sciences companies worldwide. Microsoft closely collaborates with a broad ecosystem of partners and delivers its own powerful health solutions, such as Amalga, HealthVault, and a portfolio of identity and access management technologies acquired from Sentillion Inc. in 2010. Together, Microsoft and its industry partners are working to deliver health solutions for the way people aspire to work and live.
Source: blogspot.com

Salina Public Flu Vaccine Clinic To Be Held Wednesday

A drive-thru clinic for adults only will be conducted from 11:00AM-2:00PM in the east driveway behind the 4-H Building and Agriculture Hall.  Vehicle entry will be from the south in the dirt parking area across from the entrance to Kenwood Cove.  Participants at the drive-thru must be 18 years of age or older and are asked to wear short-sleeve shirts.
Source: todayinkansas.com

Medicare Targets Health Plans With Low Ratings

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

CMS Letter on Poor Performing Medicare Advantage Plans

CMS has also created an SEP allowing beneficiaries one chance to move from a “poor” performing plan to one that is rated 3-Star or higher after January 1, 2013.  This SEP is not agent driven however, so in order for someone to take advantage of this, the individual must call 1-800-MEDICARE. There are no timeframes, end dates, etc. associated with this SEP and CMS will be granting the SEP on a case-by-case basis. Beneficiaries will be receiving letters regarding this as well.
Source: agentpipeline.com

WellPoint To Transfer UniCare Blocks

The old WellPoint Health Networks Inc., Woodland Hills, Calif., one of the companies that merged to form WellPoint Inc., created the UniCare business in 1995 to hold health insurance operations outside of California. Much of the business in the unit was acquired from Massachusetts Life Insurance Company, Springfield, Mass., in 1996 and from John Hancock Mutual Life Insurance Company, Boston, in 1997. Also today, WellPoint:
Source: lifehealthpro.com

Satisfying Retirement: Someone Explain Medicare to Me

Part D covers some of your presecition drug costs. If you don’t need a lot of drugs now, it still may be wise to take this coverage because of late enrollment penalties. Part D is provided by private insurance companies and varies widely in costs and coverage. There are usually copays and deductibles involved. The “Donut hole” limits coverage on what these plans will pay for your drugs. UNder the new health care plan, that donut hole is shrinking and has a new feature that gives you a 50% discount on covered brand name drugs. 
Source: blogspot.com

medical insurance california

googletag.cmd.push(function()googletag.display(‘div-article-top’);); When it comes to buying health insurance, a lot of options are thrown for a consumerinsurance agents, brokers and clubs that offer different plans. However, with the advancement of online technology, and the ease that it offers in buying a product, has made it possible for consumers to buy health insurance policies online. But is it simple? Is it safe buying health insurance online in Virginia? The answers to these crucial questions are hidden in the understanding of the consumer about internet technology and how efficiently he/she knows the platform from where the purchase is made. One of the most fundamental benefits of buying health insurance online in Virginia is that you wont be pressurized to make the decision immediately. Due to the absence of any human who is looking to close the deal or is coaxing you to make the decision quickly, you have all the time to search, understand and analyze before you make your final decision. In this article, we will like to discuss some points that are crucial for buying health insurance plans while residing in Virginia. While buying health insurance policies online, a consumer gets two options: 1.Buying directly from the website of the insurance company. The companies that provide health insurance in Virginia are Aetna, American National, Anthem Blue Cross and Blue, Shield, Assurant, CareFirst Blue Cross Blue Shield, Celtic, Golden Rule, Great American, Humana One, IAC, Kaiser Permanente, Patriot Health, Solera Dental, and UniCare. So, visiting the websites of any of these companies would be an option for the consumers. 2.Buying from a health insurance exchange portal where lots of companies are registered and the portal suggests the suitable plan after collecting some personal data necessary to make the right choice If you are fully confident that you want to buy from a particular insurance provider of Virginia, you can go directly to the website of that company. However, if you want to have a look at various plans offered by different companies, you can check some health insurance exchanges to find a suitable plan. Things to take care while buying health insurance online If you are buying from companys direct website Some companies do provide 15 days money-back guarantee. This should be a good option to check. Make sure you understand the medical care you need Understand the terms and conditions of the policy that you want to buy Know how to make reimbursement claims Check whether the company provides 24×7 customer care support If you are buying from a exchange portal To make sure the exchange portal is credible, talk to some of their customers who have bought health insurance from them. Online testimonials could be fake; talking in-person should be the best choice. Compare different plans based on the coverage provided and the rates associated to each one of them Know whom to contact in case you need some post-sales help regarding any issue to the medical insurance policy
Source: individualmandatehealthcare.com

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