Accountable Care Learnings in Middle Tennessee

Posted by:  :  Category: Medicare

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This is amazing. Medicare holds their data back from you until you submit your data. We were lucky enough to do 100-percent submittal. Most places don’t have the HIT in place to do it. So since we decided to go the tech route—we got 100 percent. Less than a third of the pioneer and breakout ACOs were able to do that. But because we were able to do that, they’re giving every one of our physicians PQRS certification. But once you submit your 22 quality measures, they ten turn around and give you cost metrics. So Clinigence, the group down in Atlanta, was able to harvest the EMR data and compare it with cost metrics, and we were able to prove years ago that increased quality outcomes leads to decreased costs per member. For a 65-year-old male, is his blood pressure in check, etc.; and among 30 physicians, the higher your markers of quality delivered, by the lower your month-by-month cost per member.
Source: healthcare-informatics.com

Video: ABC’s of Medicare – Tennessee Medicare Supplements and Advantage Plans

Providers Find Their Place in Managed Care for Medicaid and Dual

“Those organizations offering managed care plans are seeing an opportunity to parlay their expertise in care management into a risk-based arrangement,” says Dan Heim, executive vice president of LeadingAge New York. “Risk-based arrangements—particularly in a mandatory managed care environment—create added challenges and opportunities for not-for-profit plan sponsors. Additionally, member providers are negotiating with managed-care plans to provide services to people who need long-term care services and supports. This creates a dynamic environment for both providers and managed care plans. There is a lot of change.”
Source: leadingagetennessee.org

Blue cross blue sheild of tennessee medicare d formulary for 2013 @ Facebook alt codes on iphone :: 痞客邦 PIXNET ::

Blue Cross Prefix List (Updated Often) «. AARP MedicareRx Plans United Healthcare (PDF download) united healthcare medigap (PDF download) CIGNA HealthCare Medicare (PDF download) United Healthcare Medicaid Thank you to all of you who are commenting with more prefixes! It’s great to see this list growing. I appreciate all the feedback and some of the tips that come Health Insurance Offered by Anthem Blue. Medicare PPO Blue SM PlusRx. Monthly Plan Premium The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug Blue Cross and Blue Shield of Alabama Medicare Plans Advantage, Medigap Supplemental and Part D Coverage. Since 1936, Blue Cross and Blue Shield of Alabama’s goal has When you choose Medicare Prescription Drug coverage from Blue Cross and Blue Shield of Illinois, you receive the savings, coverage and convenience you expect. Learn Updated company news, public and media resources Mediare Advantage November 2013 Webinars; Sequestration and Medicare Advantage; Provider communications go green Blue Cross Prefix List (Updated Often) «. Medicare PPO Blue PlusRx (PPO) – Medicare.
Source: pixnet.net

Alexander , Corker Introduce Bill To Protect Tennessee Medicare Recipients …

On May 21, Senators Alexander and Corker, along with Representatives Marsha Blackburn (R-Brentwood), Phil Roe (R-Johnson City), John J. Duncan, Jr. (R-Knoxville), Chuck Fleischmann (R- Ooltewah), Scott DesJarlais, (R-Jasper), Jim Cooper (D-Nashville), Diane Black (R-Gallatin), and Steve Cohen (D-Memphis) sent a letter to CMS requesting details on its policy of awarding Medicare contracts for durable medical equipment to businesses not licensed in Tennessee, a violation of the administration’s bid policy and a violation of Tennessee state law. Durable medical equipment includes products that are intended for at-home care of sick or injured individuals. The category includes wheelchairs, crutches, blood pressure monitors, and hospital beds. 
Source: us-senators.com

Blue Cross/Blue Shield of Tennessee slashes pathology reimbursement

This is directly a result of Obamacare The increase in Medicaid applications is what is stressing out the healthcare system and payers because we cannot afford more Medicaid recipients. We are in debt in this country because we already give out too many entitlements. The behemoth labs will give Medicaid quality to ALL in my opinion. Slow turnaround time. Inaccurate results. Poor service. That is my opinion.
Source: pathologyblawg.com

Medicare Skirting Own DME Bidding Rules in Tenn.

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

Medicare Seeks To Curb Spending On Post

In McAllen, Texas, doctors and hospitals have received most of the criticism for the region’s high Medicare spending, which is greater than in any other part of the country except Miami. Medicare records, however, show inpatient hospital use and spending in 2011 was around the national average, and outpatient care was significantly below average. McAllen’s post-acute spending was the true outlier. McAllen beneficiaries were more than 2 1/2 times as likely to use home health services, long-term care hospitals and rehab facilities than were the average Medicare beneficiary in 2011. As a result, Medicare spent $4,752 per capita on post-acute services, while the national per capita spending average was $1,894. 
Source: kaiserhealthnews.org

2 Large Kansas Hospitals to Refund Medicare Overpayments

Posted by:  :  Category: Medicare

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Both hospitals only partially agreed with the OIG’s audit. University of Kansas Hospital officials said they will repay $175,653 of their recommended total, but they contested the findings on 15 inpatient claims, saying the OIG did not consider the “extenuating circumstances” those patients had. Via Christi officials said they would refund about half of the OIG’s recommended total, but the remaining billed claims were justified as inpatient.
Source: beckershospitalreview.com

Video: Kansas Medicare Supplements

MedicareBob’s Blog: Shawnee County Kansas 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

Kansas Health Care Professionals: Protect Your License, and Beware of Medicare & Medicaid Fraud

Open the newspaper or turn on the television and you are sure to see a story about the widespread prevalence of Medicare and Medicaid fraud by health care professionals. As a result, the United States Department of Justice has made it a top priority to track down those health care professionals who have engaged in such fraudulent practices. In July, a Miami psychiatrist and six other therapists were arrested on charges that they schemed and defrauded over $60 million dollars from the Medicare program. Medicare and Medicaid fraud is not only a federal crime, it can also cost a health care professional his or her professional license. One way to protect yourself and your license is to be vigilant. The following are some of the most common Medicare/Medicaid fraud schemes plaguing health care professionals:
Source: sangerlawoffice.com

Closing ‘doughnut hole’ saving Kansas seniors millions

More than 31,000 Kansas seniors and people with disabilities have saved nearly $24 million on their prescription drugs so far this year, for an average of about $750 per beneficiary, according to data released this week by the Centers for Medicare and Medicaid Services (CMS). Overall, Kansas seniors have saved more than $85 million since the Affordable Care Act was enacted and closed the “doughnut hole” gap in Medicare Part D. Nationwide, the savings is $8.9 billion, according to CMS.
Source: kansas.com

KS company paying millions in Medicare fraud case

Global Medical, Inc. and its parent company, Global Medical Direct, LLC, are mail-order diabetic supply companies.  The United States contends that, between April 1, 2008 and January 31, 2012, owners Robert Shea and Mark Franz caused Global Medical and Global Medical Direct to enter into numerous marketing contracts with insurance brokerage and other companies with customer bases likely to have a high percentage of diabetes patients and paid these companies based on the number of patients referred for diabetic supplies.  The Anti-Kickback Statute makes it unlawful to pay or receive remuneration for patient referrals because of the high-potential for billing abuse to Federal programs, such as Medicare, resulting from these types of arrangements. 
Source: hayspost.com

Caller Claims He’s with Medicare

Because of ongoing issues with the comment section we have made some changes. To improve the environment for conversation, and to make it easy to comment on stories and share them with your friends, we are now using Facebook’s commenting system. Previous non-Facebook user profiles no longer exist. You need to log in with a Facebook account in order to comment.
Source: ksal.com

Hutchinson hospital settles with feds in false Medicare claims case

The Wichita Eagle welcomes your comments on news of the day. The more voices engaged in conversation, the better for us all, but do keep it civil. Please refrain from profanity, obscenity, spam, name-calling or attacking others for their views. Please see our commenting policy for more information.
Source: kansas.com

Medicare Open Enrollment Starts Now

AARP Kansas staff and volunteers have been traveling throughout the state to try to put a stop to the confusion.  The message?  If you have Medicare or are covered by your employer’s health care plan, you don’t need to worry about signing up for health insurance through the health insurance marketplace.  However, if you are uninsured, you should visit www.healthcare.gov between now and March 31, 2014 to enroll in a plan.  Depending on your income, you may be eligible for assistance.  You must enroll by December 15, 2013 to have coverage beginning January1, 2014.
Source: aarp.org

Medicare Wellness Visits: They’re FREE…But What Are They?…By Lynne Kallenbach, M.D.

This is an excellent occasion to review recommended preventive testing, update your medication profile, and talk to your doctor about how to stay healthy. It also affords the chance to detect other concerns which might not otherwise be apparent and would warrant additional investigation. It can also provide a blueprint for the services and health issues that may need addressed over the next several years.
Source: kcim.com

MEDICARE UPDATES, FREE SCREENINGS AND MORE AT FIT AND FINE WELLNESS

Free items and health information will be available at Fit and Fine Wellness booths. Booth topics include obesity, breast feeding, COPD and asthma, benefits of volunteering, skin cancer, MRI/CT information, advanced directives, geriatric health and hospice and home care services. Medical Explorers Program information will be available for those interested in pursuing a career in health care. A KHIN exchange information booth will also be available, explaining the health information exchange program that provides access to personal health information.
Source: todayinkansas.com

Why Medicare and Medicaid remain popular programs

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

Senior Health Insurance Counseling for Kansas available to provide guidance : The Sabetha Herald

“We encourage all Medicare recipients to go online or schedule a meeting with a SHICK counselor annually to compare Medicare prescription drug plans,” said Craig Kaberline, KDADS Commissioner on Aging. “Each year Medicare Part D premiums change as well as co-pays and medications covered by the prescription drug plans. It’s always good to review your plan and make sure it’s still the best plan for meeting your needs.”
Source: sabethaherald.com

Massachusetts Health Stats: Massachusetts Man Rips Off Medicare for $27 Million

Posted by:  :  Category: Medicare

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This blog overcomes the attempts from those on both the left and right of the political spectrum to use statistics to impose needless changes on one of the best healthcare systems in the world. Massachusetts Health Stats is an as-needed look at statistics about the Massachusetts healthcare delivery and insurance market and industry, including — occasionally — aspects of Medicare as they relate to Massachusetts seniors and the Medicare-eligible disabled. For Medicare-specific information with nationwide implications and some how-to hints for seniors see http://byrondennis.typepad.com/theabcsofmedicare/
Source: typepad.com

Video: Medicare Supplemental Policy in Massachusetts by Medicare Pathways

Medicare Seeks To Curb Spending On Post

In McAllen, Texas, doctors and hospitals have received most of the criticism for the region’s high Medicare spending, which is greater than in any other part of the country except Miami. Medicare records, however, show inpatient hospital use and spending in 2011 was around the national average, and outpatient care was significantly below average. McAllen’s post-acute spending was the true outlier. McAllen beneficiaries were more than 2 1/2 times as likely to use home health services, long-term care hospitals and rehab facilities than were the average Medicare beneficiary in 2011. As a result, Medicare spent $4,752 per capita on post-acute services, while the national per capita spending average was $1,894. 
Source: kaiserhealthnews.org

If Obamacare is the next Medicare, will physicians leave en mass?

But if Fisher and his colleagues essentially are forced to opt out of the Affordable Care Act because of diminished reimbursements and challenging mandates, finding an acceptable doctor on the health care exchanges who is taking new patients could put medical consumers in a critical condition, according to Joshua Archambault, health care policy and program manager for the Pioneer Institute,a nonpartisan, privately funded, Massachusetts-based think tank.
Source: sayanythingblog.com

Statement of the Home Care Alliance of Massachusetts on CMS’ Final Rule Slashing Home Health Care Payments

Accessibility Accountable Care Organizations Accreditation ACO Affordable Care Act alzheimer’s Amedisys Home Health & Hospice Care Annual Report Billing Boston Marathon Boston Marathon Bombing Careers in Home Care Caregiver Care Giver Care Giver Resources Caregiving care transitions CDC CMS Dementia Care dual eligibles Education Emergency Prep End-of-Life Care EOEA Face-to-Face Falls Prevention Family Caregiving Family Care Provider federal budget Federal Regulations Flu Flu Season Geoffrey Abraskin HIPAA Home Care Home Care Agencies Home Care Aide Home Health Home Health Care Home Health Compare hospice House of Representatives ICD-10 innovation Innovations Showcase Managed Care Massachusetts MassHealth Mass Regulations Medicaid Medicare MOLST New England Careers New England Home Care Conference & Trade Show NHIC Northeast Home Health Leadership Summit nurse delegation nursing OASIS-C Palliative Care patient choice Patient Satisfaction PECOS PPS Private Care Quality Quality Reporting Referrals Star Awards State Budget telehealth therapy U.S. Congress VNA
Source: wordpress.com

Medicare Open Enrollment Means Time to Evaluate Your Current Coverage

Massachusetts residents who need help figuring out their Medicare options should contact SHINE (Serving the Health Information Needs of Elders), a free program that provides health insurance counseling. Visit the Massachusetts Executive Office of Elder Affairs for SHINE information, or check this SHINE telephone directory by city or town (pdf), or visit ageinfo.com, call toll-free 1-800-AGE-INFO (1-800-243-4636), or contact your local Council on Aging or Senior Center.
Source: aarp.org

Massachusetts, Minnesota, and Wisconsin Medicare Supplement Plans

Unlike most states, which offer the option to enroll in one of 10 standard Medigap policies, Massachusetts, Minnesota, and Wisconsin offer Medicare Supplement plan offerings that are unique to these states. Medicare Supplement (Medigap) plans are available as an option to get coverage for out-of-pocket costs not already covered by Part A and Part B. In most of the United States, eligible beneficiaries can choose from 10 standardized Medigap plan offerings, with plans named the same letter offering the same benefits no matter what state the plan is offered in. However, as stated previously, not all beneficiaries have the option to enroll in one of these standard Medigap policies.
Source: planprescriber.com

DownWithTyranny!: Today Is Election Day In Massachusetts

Whoever wins the Democratic primary in MA-05 today will be Congress’ next member– and they walk right into the dysfunctional mess in DC. Only one candidate is prepared to walk into that mess and take a significant role and that’s Carl Sciortino. No way to be sure who’s going to win today. The EMILY’s List candidate, Katherine Clark wrote herself a check for a quarter million dollars to buy the seat and EMILY’s List continues to pour massive amounts of money into the race– another $58,666 just last week from their shady Women Vote SuperPAC that ran the misleading ads suggesting that Elizabeth Warren endorsed their horribly flawed pro-domestic spying candidate. Warren, of course, refused to do any such thing. In fact, all the congressional progressives who have endorsed in this race– Alan Grayson, Raul Grijalva, Mark Takano, Jared Polis and Keith Ellison– have endorsed Sciortino. Sunday night Grayson sent out a finally message to his Massachusetts supporters urging them to get out and vote for Carl.
Source: blogspot.com

Massachusetts Medicare subscribers save $36.9 million

This statement does not make it clear that it is just as much programs such as Prescription Advantage as seniors that get the so-called savings. I have no problem with the savings, just your wording. But basically there is no reason for anyone in Massachusetts on Medicare, even if making as much as $55,000 in retirement, to be very highly penalized by the donut hole (and again, less than one in 10 are likely to fall into it in the first place)
Source: fiftyplusadvocate.com

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