Myriad Shares Recover after Medicare Contractors Confirm Error on BRCA1/2 CPT Code Price

Posted by:  :  Category: Medicare

An international team led by investigators at the University of Colorado School of Medicine report on findings from a study of the Burmese python genome. Using Illumina and Roche 454 sequencing, the researchers sequenced and put together a 1.44 billion base genome assembly for the Burmese python, Python molurus bivittatus. Together with transcriptome sequence data from several Burmese python tissues before and after prey consumption, the genome made it possible to peek at expression changes accompanying peculiar Burmese python prey consumption traits such as feeding-related changes to organ sizes. By comparing Burmese python sequences to those of several other animals, meanwhile, the team tracked down sequence and genome structure shifts that contributing to other notable snake traits and adaptations.
Source: genomeweb.com

Video: Humana Made Medicare Easy

Are You Ready for Another Medicare Transition?

The Centers for Medicare & Medicare Services (CMS) first announced in September 2012 that Noridian Healthcare Solutions has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in California, Nevada and Hawaii, as well as the U.S. 
Source: practicons.com

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

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

Update: Upcoming CMS Jurisdiction JE Medicare Contractor Change

Update The clearinghouse has received the following information regarding the Jurisdiction JE Medicare Contractor change to Noridian Administrative Services, LLC (NAS). Please be aware: • The clearinghouse is working closely with Noridian’s Electronic Data Interchange Support Services (EDISS) to ensure a transparent and efficient transition: – The clearinghouse will conduct transition submission testing – The clearinghouse is currently reviewing the option of Early Boarding • Total On Boarding (TOB) has been updated with provider’s transactions and contact information: – TOB is Noridian’s online registration tool that allows providers to update basic facility information, manage NPIs, update lines of business, add or change vendor associations and select electronic transactions online – Providers should familiarize themselves with the Noridian Total On Boarding registration system for registering new providers – Providers can contact the payer directly at 800-967-7902 for more information • Noridian is offering providers a variety of training opportunities such as Web-based workshops, in-person workshops tutorials, and teleconference. A schedule of events can be found at https://www.noridianmedicare.com/je/schedule.html • Provider Contact information for Jurisdiction JE EDI Support Service is: – Phone 855-721-4184 – Fax 701-277-7850 – Email: support@edissweb.com – Website www.edissweb.com Action Required: Providers should contact Noridian Medicare Services at 855-721-4184 or by email support@edissweb.com with questions regarding the Jurisdiction JE Medicare Contractor change. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Noridian doubles its federal business volume with new contract

Noridian will be the Medicare Administrative Contractor (MAC) for Medicare Part A and Part B for California, Nevada, Hawaii, Guam, American Samoa and the Northern Mariana Islands — Jurisdiction E (JE). This area represents 9 percent of the total volume of Medicare Fee-for-Service claims administration business nationwide. Combined with its other existing Medicare claims contracts, Noridian will now administer a total of approximately 15 percent of Medicare’s national volume of business.
Source: ndakotabusiness.com

MDx/CDx Focus: Myriad's Prolaris Initially Denied by Noridian; Life Tech's Pervenio Lung Cancer Dx

An international team led by investigators at the University of Colorado School of Medicine report on findings from a study of the Burmese python genome. Using Illumina and Roche 454 sequencing, the researchers sequenced and put together a 1.44 billion base genome assembly for the Burmese python, Python molurus bivittatus. Together with transcriptome sequence data from several Burmese python tissues before and after prey consumption, the genome made it possible to peek at expression changes accompanying peculiar Burmese python prey consumption traits such as feeding-related changes to organ sizes. By comparing Burmese python sequences to those of several other animals, meanwhile, the team tracked down sequence and genome structure shifts that contributing to other notable snake traits and adaptations.
Source: genomeweb.com

FDA Law Blog: Medicare Revokes Payment for ARANESP

FDA Law Blog is published for informational purposes only; it contains no legal advice whatsoever. Publication of FDA Law Blog does not create an attorney-client relationship. FDA Law Blog is the blog of Hyman, Phelps & McNamara, P.C. (“HPM”) and it is intended primarily for other attorneys and regulatory professionals. No part of FDA Law Blog –whether information, commentary, or other– may be attributed to HPM’s clients. Readers should be aware that HPM represents many companies in the food, drug, medical device, and health care industries, and therefore FDA Law Blog may occasionally report on news that relates to HPM clients. FDA Law Blog will always strive to be unbiased in its reporting. All information on FDA Law Blog should be double-checked for its accuracy and current applicability. Copyright 2011 Hyman, Phelps & McNamara, P.C.
Source: fdalawblog.net

Lesson Is Seen in Repeal of 1989 Law on Medicare

Posted by:  :  Category: Medicare

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WASHINGTON — Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn’t appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in.
Source: realclearpolitics.com

Video: NY Healthcare Lawyer | RAC Audits for Medicare or Medicaid (HL 2)

New York lags nation on hospital quality test, costing city millions in aid

The quality incentive program follows a carrot-and-stick principle: the Centers for Medicare and Medicaid Services pools 1.25 percent of the value of its annual payments into a $1.1 billion pot, and redistributes it unevenly to hospitals nationwide depending on performance. Hospitals are evaluated on measures that range from clinical procedures to mortality rates and satisfaction among their Medicare patients. Improvement compared to the last evaluation is also rewarded. Winners receive bonus funds, while losers get penalized on their Medicare payments, up to 1.25 percent of a hospital’s Medicare income.
Source: thenewyorkworld.com

NY Identifies $496 Million in Home Health Medicaid Error Payments

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 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 USA Today VA Visiting Nurses Association
Source: homehealthcarenews.com

NY case: Union challenges discontinuation of Medicare Part B premium reimbursements

FosterThomas is a leading professional services company that provides solutions in the areas of Human Resources Consulting and Outsourcing, HR Staffing, Outsourced Recruiting, Employee Benefits Brokerage, Payroll Implementation and Services, HR for Government Contractors, Business Insurance, HR Compliance and Risk Management. We help organizations by providing solutions designed with a focus on cost containment strategies and increasing HR efficiency. FosterThomas HR Consulting was established in 1993 with offices in Annapolis, Maryland (Corporate), McLean, Virginia and Raleigh, North Carolina. Today, FosterThomas occupies a unique position as a full service provider of HR services.
Source: fosterthomas.com

NY Times Prints Apples vs. Oranges Study on Medicare Costs and Income

The problems with the latest study are identical with those in the comparable “study” issued by the Social Security Administration through the office of Sen. Marco Rubio (R-Fla.). That document showed that if you take a snapshot of the situation you will find that immigrants pay more into the Social Security Trust Fund than they take out, as discussed in this CIS report. The SSA’s tabulations did not touch on the life-long balance of Social Security costs of natives and immigrants, just the short-term balances, which are heavily influenced by the relative youth of the adult migrants.
Source: cis.org

Difference between Medicare Part A B C D

Posted by:  :  Category: Medicare

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Finding the best Part D coverage.  Visit the Medicare website each year to review your coverage and ensure it is the best plan for you.  You may also visit your insurance agent to review plans that they offer – or check with your pharmacist to see if there are any programs available in the area to learn more about the plans offered.
Source: pharmacisttips.com

Video: Medicare Part A, B, C and D Explained

Medicare Part D Prescription Drug Plans

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

Understanding Medicare Part A, Part B, Part C and Part D

But as complicated as all that sounds, there’s a single key choice at the core of all your decision-making: Will you go with the Original Medicare plan, which is run by the federal government and consists of Parts A and B, or a Medicare Advantage plan (also called Part C) that is offered by a private insurer and approved by Medicare? Medicare Part A — Your Hospital Coverage When you apply to Medicare, you are automatically enrolled in the Part A plan. Part A is your hospital insurance plan. It covers nursing care and hospital stays, although not doctors’ fees. Part A also covers some home health services, skilled nursing care after a hospital stay and hospice care. You likely won’t have to pay a monthly premium for Medicare Part A, thanks in part to all the payroll taxes you paid while you were employed. You must, however, pay a yearly deductible before Medicare will cover any hospitalization costs. For 2011, the Part A deductible is $1,132.
Source: aarp.org

Medicare Spending and Financing Fact Sheet

The Part A Trust Fund is projected to be depleted in 2024—eight years longer than in the absence of the health reform law—at which point Medicare will not have sufficient funds to pay full benefits, even though revenue flows into the Trust Fund each year.  Part A Trust Fund solvency is affected by growth in the economy, which directly affects revenue from payroll tax contributions, and by demographic trends:  an increasing number of beneficiaries, especially between 2010 and 2030 when the baby boom generation reaches Medicare eligibility age, and a declining ratio of workers per beneficiary making payroll contributions.  Part B and Part D do not have similar financing challenges, because both were structured to be funded by beneficiary premiums and general revenues, set annually to match expected outlays.  However, future increases in spending under Part B and Part D will require increases in general revenue funding and higher premiums paid by beneficiaries.
Source: kff.org

Worst Medicare Advice You’ll Ever Get from an Insurance Agent

Part C Medicare Advantage health plans will NEVER make paying for any kind of health care service "more expensive" than paying for that same service simply using Original Medicare Parts A and B. Part C Medicare Advantage health plans are not right for every senior (which is why the "Medicare and You, 2013" booklet shows options on page 15–see illustration above) but Part C plans are always better for seniors than Original Medicare. Almost no senior citizen in the United States depends on Original Medicare. Original Medicare charges an unlimited number of $1165 deductibles per year for admitted-inpatient hospital visits and 20% for all other services (even more if the doctor involved does not "accept assignment"). Original Medicare has lifetime limits that can potentially bankrupt seniors. Unlike Original Medicare, all Part C Medicare Advantage health plans have annual out of pocket (OOP) limits and typically nominal $20-$40 copays for doctor visits (but every Part C plan is different so you need to do the math).
Source: typepad.com

Compare Medicare Supplement Insurance Benefit Plans A, B, C, D, E, F, G, H, I, and J

Original Medicare pays for the first 20 days of skilled nursing care and a portion of days 21-100.  Plans C-F cover the remaining portion not covered by Medicare during days 21-100 ($133.50 per day in 2009).  It is important to note that neither Medicare nor supplemental insurance  pays for care beyond day 100.  Consequently, many seniors purchase a long term care insurance policy.
Source: ohioinsureplan.com

Can I use my Health Savings Account to pay for Medicare Advantage premiums?

In June of 2012 I will be turning 65, becoming eligible for Medicare. I have a high deductible individual insurance policy with a health savings account. What I would like to know is if I can use the money in the health savings account to pay premiums on an Advantage Plan, Prescription Drug Plan or Medigap policy without paying income taxes on the health savings account money used for that purpose?– Bruce Backman, West Columbia, S.C.
Source: cnn.com

Washington State, Medicare ready to launch partnership aimed at “dual eligibles” : The Suburban Times

Posted by:  :  Category: Medicare

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“Working with CMS is a milestone in our efforts to track and better serve the so-called ‘dual eligibles’ – those Medicaid clients who are also covered by Medicare,” said MaryAnne Lindeblad, state Medicaid director. “We will be providing integrated medical, behavioral health, and long-term services and supports in those two urban counties, looking to set standards that ultimately will be used by other states as well as our own.”
Source: thesubtimes.com

Video: AARP, Medicare and DSHS ( Washington State)

The other Washington could hold the key to Medicare's cost crisis

 But in Washington state, which is known for its progressive politics, the measure, requested by former Democratic Gov. Christine Gregoire, sailed through the legislature, albeit with an appeals process amendment the governor vetoed. “Medicare should be doing this, but it gets rolled by the Congress,” said Dr. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission (MEDPAC), an independent agency that advises Congress on issues affecting Medicare. Berenson pointed to several high-profile examples of Congress meddling with coverage policy, including the case of the late Sen. Ted Stevens of Alaska, who at the behest of the PET scan industry almost single-handedly forced Medicare to cover the scan as a test for Alzheimer’s, a policy that existing science did not support.
Source: publicintegrity.org

Childhaven’s future uncertain after feds pull Medicaid money

Wilcox, Childhaven’s president, said shutting down the Auburn and Burien centers or otherwise curtailing operations would deprive vulnerable children of one of their few safe havens. Some 20 percent of the children live with relatives other than their parents. An additional 15 percent are in foster care, and 5 percent are in the process of being adopted.
Source: seattletimes.com

Judge’s Medicare Advantage Order Could Have National Impact

The preliminary injunction issued by U.S. District Court Judge Stefan Underhill comes less than 48 hours before a deadline at midnight tomorrow for seniors to choose a Medicare Advantage or drug plan for next year. Medicare officials said they don’t plan to extend the deadline for beneficiaries affected by the terminations, but will continue to monitor the situation. After the deadline, Medicare Advantage members are allowed to make one change from Jan. 1 through Feb. 14 — they can leave their plan and rejoin traditional Medicare.
Source: kaiserhealthnews.org

CMS Updates Medicare Physician Fee Schedule, Other Part B Policies for CY 2014 : Health Industry Washington Watch

CMS did not finalize a controversial proposal under its potentially misvalued code initiative to reduce PFS rates for more than 200 codes if Medicare physician office payment exceeds the payment under the hospital outpatient prospective payment system (OPPS) or ambulatory surgical center (ASC) prospective payment system (PPS). CMS expects to develop a revised proposal for using OPPS and ASC rates in establishing physician practice expense relative value units, which CMS will propose through future notice and comment rulemaking. CMS is continuing its efforts to identify and adjust payment for potentially misvalued codes, however, including by adopting on an interim basis work relative value units for approximately 200 additional codes. These interim values are subject for public comment until January 27, 2014.
Source: healthindustrywashingtonwatch.com

Washington Medicaid increases dental coverage for adults

Bracken Killpack, vice president of government affairs for the Washington State Dental Association, said the state has among the highest ratios of dentists to population in the country and should have the capacity to handle the increase. It helps that, unlike medical practices, where specialists outnumber general practitioners, about 80 percent of dentists are in general or family practice, he said.
Source: spokesman.com

HCAN Report Reveals Human, Economic Costs of States’ Rejection of Expanded Medicaid Funding

WASHINGTON, D.C. Dec. 10, 2013 – Governors and lawmakers in 25 states who reject federal support to expand state Medicaid programs are sacrificing thousands of lives and pushing away enormous economic development benefits that come with $426 billion in direct funding over 10 years, according to a new report by Health Care for America Now (HCAN), the nation’s leading grassroots health care advocacy group. While states that fully participate in Medicaid provisions of the Affordable Care Act (ACA) will enjoy new federal investment and improved economic growth, residents of states rejecting Medicaid expansion face a declining quality of life, a weaker economy and destabilized hospitals—including some that will be forced to close, according to the report. Research at the Harvard School of Public Health suggests that the 25 states’ refusal to accept the Medicaid funds may result in the deaths of 27,452 Americans in 2014 as those states forgo funding of health benefits that are expected to reduce mortality rates for low-income adults. “Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents,” said Ethan Rome, HCAN’s executive director. “In addition to rejecting billions and denying care to millions, they’re consigning thousands to death. This policy choice is not only unconscionable, it harms everyone in those states whether insured or not. Perhaps the greatest irony of refusing the ACA funding is that it will impose higher costs on insured people in states that claim they can’t afford to expand Medicaid.” Yesterday supporters of the ACA around the nation talked about the benefits of Medicaid expansion. Today in LIVES AND LIVELIHOODS LOST: The High Cost of Rejecting Medicaid Expansion, HCAN reports these key findings: § Medicaid expansion can be expected to reduce mortality rates among low-income adults to 6.1 percent below that of neighboring states that reject the program. Extending Medicaid benefits to this population prevents 2,840 deaths per year for each 500,000 adults gaining coverage, according to a study by Harvard researchers in the New England Journal of Medicine. Based on this formula, governors and state lawmakers who are blocking access to health care for 4.8 million low-income people will prevent Medicaid from saving 27,452 lives in 2014 alone. § Hospitals in non-expansion states will be put at a significant competitive disadvantage, resulting in insurance companies excluding them from provider networks because the hospitals must charge insured patients higher fees to cover uncompensated care costs. Hospital administrators will offset lost network business by increasing out-of-pocket costs for people with private insurance, according to a hospital finance expert and medical school professor at Johns Hopkins University Bloomberg School Public Health. Hospitals in those states are already being negatively affected with higher borrowing costs in Wall Street bond markets from which they obtain funds for construction and other major projects. § While rejection of Medicaid expansion and other ACA programs may satisfy the ideological fervor of many Republican officeholders, it does not relieve health care providers of the legal and ethical obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and Labor Act. That law was enacted with President Ronald Reagan’s approval in 1986. The cost of complying with emergency treatment laws will not go away, and the burden of uncompensated care must be borne by hospitals, doctors, local taxpayers and charities. “In 2009, extremist Republicans intentionally spread phony stories about ‘death panels’ to scare Americans into thinking the law would block their medical care when they needed it most,” said HCAN Executive Director Ethan Rome. “Now it’s clear that the only real death panels consist of Republican governors and lawmakers who are choosing to block the doorway to state Medicaid expansion and keep nearly 5 million Americans away from the medical care they need.” Health care providers across the country witness the damage caused by unaffordable care and are pushing states to cover more people through Medicaid. “Every day, SEIU’s nurses and doctors see what happens when patients delay or forgo necessary health care because they can’t afford it,” said Dr. L. Toni Lewis, Chair of SEIU Healthcare and a board certified family physician. “By refusing to expand Medicaid, extremist politicians have chosen to deny millions of families the care they desperately need and deserve.” Key provisions of the ACA will take effect on Jan. 1, 2014, when millions of uninsured Americans will begin using subsidized private health plans or expanded Medicaid eligibility to protect themselves and their families from disastrous medical costs. Washington has devoted five years of raucous public debate to the law so far, and the controversy has shown no sign of letting up as implementation of the ACA’s broadest provisions draws nearer. In October, Republicans shut down the government in a failed effort to force repeal of the ACA. Opponents of health reform, including special interest groups spending unprecedented sums of money to undermine the law and its base of public support, have tried every available weapon in their arsenal of legislative, political, legal, regulatory and communications tactics. These include putting intense political pressure on governors deliberating over whether to fully participate in Medicaid. The question for leaders in those states is whether they will rationalize politically motivated policy choices that will inflict serious harm on their own economies and the quality of life for millions of people. Florida is one of the largest states to say no to Medicaid expansion, and progressive advocates are putting the spotlight on this historic failure of leadership. “Shame on Gov. Scott and House Republican leaders for failing to expand Medicaid,” said Mishell Warner, a Miami Gardens nurse and member of AFSCME. “I know how devastating this is for the working poor who desperately need health care coverage. There is federal money on the table to get this done, but our political leaders are failing to put the needs of Florida ahead of their political agenda.” To view the complete report, go here. Health Care for America Now, the nation’s leading grassroots health care coalition, works to promote and defend the Affordable Care Act, protect Medicare and Medicaid, and advocate for fair taxes to support public services.
Source: yubanet.com

Washington State Insurance Update: Medicare open enrollment started this week and ends Dec. 7

Medicare’s open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 – Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage. If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state. Remember, if you want to enroll in  new plan, you must contact Medicare. You cannot sign up through the state’s new health benefit exchange, www.wahealthplanfinder.org. If you have limited income and need help paying prescription drugs, check out Medicare’s “Extra Help” program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov. For more help, contact a local SHIBA office in your area.
Source: blogspot.com

medicare supplemental INSURANCE washington state

Government designed plans are the Medicare Supplements or Medigap policies. They come in 12 standard choices with two of the choices available with a simple modification. The choices are called Plan A. Plan B. Plan C. Plan D. Plan F. Plan G. Plan K. Plan L. Plan M and Plan N. The modified plans are the High Deductible Plan F and the High Deductible Plan J. As the letters increase from A to N. the coverage generally increases and the premiums are generally higher. Plans K and L are lower coverage and lower cost alternatives. The high deductible versions simply impose a deductible before the INSURANCE company pays any benefits as a way to cut your health INSURANCE premium costs.
Source: meximas.com

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December 12, 2013

Understanding Medicare Coverage for Lung Cancer Treatment

Posted by:  :  Category: Medicare

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Medicare recognizes that prevention is the best medicine and to that end, the agency strives to help smokers quit using tobacco before they are diagnosed with lung cancer or another tobacco-related illness. If you haven’t yet been diagnosed with lung cancer or a similar disease, you could pay nothing for up to eight visits with a healthcare provider for the purpose of smoking cessation.
Source: plantationgeneralblog.com

Video: How to Understand Medicare Plans

Understanding What Medicare Supplmental Insurance Is All About

While some insurance policies will cover issues like vision care and dental, most do not. Again, it is important that spouses each purchase their own separate supplemental coverage. This is important as couples have differing conditions medically. It is important that you discuss these issues with an expert for you purchase covers that befit each of you.  We found great help for Medicare supplements at MedicareSupplementQuotes.net.  The articles were informative and the medigap quotes were quick and accurate.
Source: tablib.org

Understanding the difference between Medicare and the Marketplaces

A: Similar to last year’s schedule, Medicare’s open enrollment period runs from Oct. 15 to Dec.  7. During Medicare open enrollment, you can decide whether to change plans, join a new plan, or keep the same Medicare coverage you have. If you have a Medicare Advantage or Part D prescription drug plan, you should see if your plan will be changing in 2014 and you should assess whether your medication needs have changed. If you have traditional Medicare, you can think about whether you want to join a Medicare Advantage plan. Thanks to the ACA, Part D drug coverage will continue to improve in 2014, and Medicare will continue to cover most preventive benefits with no copayments. You can learn more, by going online towww.medicare.gov or by calling 1-800-MEDICARE. For personalized counseling, ask for a referral to your state health insurance assistance program (SHIP).
Source: seniordigestnews.com

Understanding Medicare important for seniors’ well

, the news is full of more health care and insurance jargon than ever: Health insurance marketplaces. Premium subsidies. Essential health benefits. All of this buzz can make it difficult for the more than 270,000 Medicare beneficiaries in the Las Vegas area to cut through the clutter and find the information they need about their Medicare options for 2014. That may help explain why the Medicare Made Clear Index, a survey of 1,000 older adults conducted earlier this year, found that most beneficiaries’ understanding of Medicare is limited. Baby boomers in their early 60s, who are approaching Medicare eligibility and may be a caregiver for a parent or loved one who receives Medicare benefits, reported the lowest confidence levels in their Medicare knowledge of all survey participants, with most saying they have a “fair” or “poor” understanding of the program. This is concerning because Medicare is not a one-size-fits-all program, and coverage decisions can have a significant impact on beneficiaries’ health — and wallets. Whether you’re a baby boomer preparing to enroll in Medicare for the first time, a beneficiary considering making a change to your coverage, or a caregiver for someone who receives Medicare benefits, you should know that these decisions require thoughtful planning. The good news: They don’t have to be a struggle. The goal of National Medicare Education Week (Sept. 15-22) was to help people learn more about Medicare so they can find coverage that’s a good fit for their individual needs. It starts one month before Medicare’s annual Open Enrollment Period (
Source: lasvegastribune.net

Is Medicare Too Hard to Understand for Seniors?

On October 15th, 2013 millions of senior citizens around the United States will be eligible to change their current medicare insurance provider during an open enrollment period. This open enrollment period begins on October 15th and concludes on December 7th of this year. Unfortunately, there is very little that would be described as easy when it comes to understanding medicare in the United States. Medicare supplement insurance, also known as Medigap, is available in Part A and B but not Part C. Part D is simply a prescription drug plan. There is a Part E. Different insurance companies offer different prices. Each insurance company has to adjust prices based on county and state. It is endless when it comes to the complex system the government has in place for senior citizen health insurance. This is the reason many feel as if medicare is too hard to understand for seniors.
Source: wealthcareforwomen.com

Medicare Spending For Medical Imaging Sustained Dramatic Slowdown Compared With Other Services

The new study, published in the December issue of the American Journal of Roentgenology (AJR), sought to develop a comparative understanding of Medicare spending growth for medical imaging vis-à-vis other services. By analyzing Medicare claims data, researchers found that though medical imaging (and especially advanced medical imaging) was, at a time, one of the fastest growing categories of Medicare spending, that position has essentially reversed in the past 5 years. The findings indicate that while spending growth on diagnostic imaging was in the 80th percentile of all medical services in 2001, it had slowed to the point that it was only in the second growth percentile by 2011. These results hold for imaging as a whole, as well as advanced (such as CT and MRI) and standard (such as x-ray and ultrasound) imaging services.
Source: healthcaretechnologyonline.com

Understanding Medicare Billing and Reimbursement Coding

Medicare pays for physician services under Part B according to the Medicare Fee Schedule (MFS).  Medicare reimburses other healthcare providers, such as acute inpatient hospitals, home health agencies, hospice, outpatient hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities, through mechanisms known as Prospective Payment Systems (PPS). PPS reimbursements are made based on a predetermined, fixed amount.  The payment amount for a service is determined based on the classification system of that service.  For example, inpatient hospital services are reimbursed on the basis of diagnosis-related groups (DRGs), and outpatient hospital services are reimbursed on the basis of Ambulatory Payment Classifications (APCs).
Source: jameshoyer.com

Understanding Medicare’s Supplemental Insurance

Your Medicare policy will take care of initial payments, while the Medigap policy will cover the expenses left over. If your Medigap policy doesn’t cover everything, then the remaining extras will have to come out of your own pocket. Co-payments, deductibles and un-covered expenses only increase as you age, so having an additional policy makes good financial sense.
Source: 360signals.com

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