Medicare Appeals Process Forms

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A party may appoint any individual, including an attorney, to act as his or her representative to help the party during the processing of a claim or claims and /or any appeals of claims. A representative may be appointed at any time during the appeals process. The party making the appointment and the individual accepting the appointment must either complete an appointment of representative form (CMS-1696, CMS-1696 Spanish) or use a conforming written instrument. If the form CMS-1696 is not used, the written request must contain all of the elements listed in 42 CFR 405.910. The appointment of representative is valid for one year from the date it is signed by both the party and the appointed representative. A detailed explanation of appointment of a representative can also be found in the CMS Internet Only Manual (IOM) 100-4, Chapter 29, section 270.
Source: findacode.com

Medicare Part C Appeals > Home

Attention Medicare Health Plans- Updated Medicare Advantage Process Manual, Appendix, Reconsideration Background Data Form, and Dismissal Case File Data Form are now available under the ‘Health Plans’ section. Plans should begin using the new Reconsideration Background Data Form for appeals submitted to MAXIMUS Federal Services effective 1/1/2015. For dismissal review cases files submitted to MAXIMUS upon request after 1/1/14, health plans must use the Dismissal Case File Data Form.
Source: medicareappeals.com

Medicare Advantage Leads, Medicare Supplement Leads, Turning 65 Leads

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Medicare advantage leads (Medicare insurance leads) generating service with Senior Sales®, Texas based telemarketing firm is the right choice. We are producing Medicare leads prospects in the form of scheduled appointments and telemarketing leads. Company offers a streamline of Marketing services such as: Medicare Advantage leads, Medicare Supplement Leads, Special Need, Dual Eligible leads, Turning 65 Leads (Seniors 64 and 65 with Medicare Part A and Medicare Part B), Medicare leads list and other types of senior prospects.
Source: medicareadvantageleads.com

Medicare Supplement Leads, Advantage Medicare Leads

Senior Sales Inc. is a telemarketing company based in Texas since 2006. We generate quality Medicare leads in the form of preset appointments such as Turning 65 Leads (Seniors 64 and 65 years old), Medicare supplement leads, dual eligible leads and special needs as well as Home Care Non-Medical and Home Health Care marketing lead services. Senior Sales has the highest quality trained staff within the market. Staffing is solely based on client directives for prospect generation such as yours. Our market allows for quick and effective training and staffing of a high quality work force. Here you will be able to order absolutely exclusive and affordable telemarketing Medicare leads in the form of preset appointments or phone referral leads. To accommodate a large customer base our companies have a huge online support which will assist to host all call center service operations and reduce cost of generated Medicare supplement leads.
Source: medicare-leads.com

Medicare Advantage Specialists

MAS is your partner for comprehensive solutions in the booming senior life and health insurance market, including Medicare Advantage, Medicare Supplements, Final Expense Life Insurance, Critical Illness, Hospital Indemnity, Long Term Care plans and more!
Source: medicareadvantagespecialists.com

Medicare Supplement Leads

Precision Senior Marketing offers discounted insurance leads for its agents through some of the market’s most competitive lead service companies. Why pay full price, when you can leverage the PSM community to get a higher ROI on this great investment that can grow your business quickly? Through partnerships with Kramer Direct, USADATA, and ProspectZone, PSM agents have exclusive offers and preferred pricing on internet, direct-mail, and call leads. At PSM, we understand that you need reliable, high-quality insurance leads, so we only work with the best companies in the industry. Each company offers insurance leads for all insurance products, including Medicare Supplement, Medicare Advantage, Long-Term Care, Final Expense, Term Life, Annuities and Senior Health. No matter what products are in your portfolio, you are sure to find the exact insurance leads you are seeking with one of our partner companies.
Source: psmbrokerage.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Obamacare’s Impact on Medicare Advantage

Build on the steady progress in risk adjustment. Risk adjustment is a tool used to address selection bias in Medicare Advantage and other private insurance programs. The goal is to mitigate an insurer’s ability to tailor plans to attract a disproportionate share of the most profitable enrollees—healthier enrollees that consume less medical services. Every major Medicare reform proposal, based on premium support, would provide risk adjustment or significantly improve the risk-adjustment formulas or mechanisms that currently exist in the MA or Medicare Part D program. Risk adjustment could either be prospective or retrospective. Prospective risk adjustment already characterizes Medicare Advantage and Medicare Part D, where government per capita payments are adjusted by demographic factors, such as age, sex, institutional or Medicaid status, and medical conditions. Retrospective risk adjustment—back-end adjustments—would be based on new pooling arrangements, such as a risk-transfer pool. In that arrangement, health plans that attracted higher-risk or more costly patients would be cross-subsidized by plans that attracted fewer high-risk or less costly patients. The value of these types of arrangements is that they would be based on hard data and not on educated guesswork or projections. The Wyden–Ryan plan, for example, includes such an approach. The Heritage proposal would include both prospective and retrospective risk adjustment. Applying the lessons from MA’s risk-adjustment experience could mitigate the risks that only the unhealthy would be stuck in Medicare fee-for-service plans, leaving the plans’ costs to escalate and grow further away from the premium support benchmark, and thus more expensive for enrollees. Over the past decade, as Alice Rivlin and others have noted, the risk-adjustment mechanism used in Medicare Advantage has significantly improved and succeeded in reducing favorable selection in the program. In the future, with the adoption of defined-contribution financing for the entire Medicare program, one can expect further refinements and innovative approaches to adjusting government per capita payments. One particularly interesting approach has been developed by Zhou Yang, professor of economics at Emory University. Professor Yang’s proposal, to be implemented within an environment of competitive health plans, would tie Medicare payments to positive behavioral changes: Enrollees would be rewarded for enrollment in wellness or preventive-care programs that promote a healthier (and thus less costly) lifestyle.[44]
Source: heritage.org

Population Health Management In Medicare Advantage

Wellnesss promotion.  A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition).  In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk.  Health risk assessments used universally by MAOs serve to segment populations at risk for disease.  For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.
Source: healthaffairs.org

Highmark loses some commercial, Medicare members in W. Pa. for 2015

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Mr. Holmberg and Anthony Benevento, Highmark’s senior vice president of Pennsylvania markets, also noted that the insurer fared well when employers gave their employees a choice between two or more health plans. When an employer offered multiple carriers for 2015 — Highmark, plus one or more carriers that offer full UPMC access — Highmark retained 71 percent of those employees.
Source: post-gazette.com

Judge rules UPMC must accept Highmark Medicare Advantage members

While Highmark spokesman Aaron Billger said the Pittsburgh insurer was pleased the court agreed with state regulators “that UPMC cannot walk away from 182,000 seniors in our community,” UPMC spokesman Paul Wood said the health system will appeal the order and is “confident the Commonwealth Court’s order will be reversed.”
Source: post-gazette.com

Medicare Information for Retirees

Posted by:  :  Category: Medicare

Annuitants and certain individuals on subsidized extended coverage age 65 or older who wish to pay subsidized rates for health insurance premiums must enroll in the Medicare Advantage (MA) PPO Standard or Premium option offered by Blue Cross Blue Shield of Georgia (BCBSGa).  See Plan Documents for rate resolutions and annuitant subsidy policies.
Source: georgia.gov

Georgia Medicare Supplements

Georgia Medicare Supplements provides an added bonus as well as competitive rates: a staff that is dedicated to helping you complete your application and answer any questions you may have before or after you receive coverage. This includes discussing health conditions, the six-month waiting period, rate guarantees, and premium changes that might matter to you while getting your coverage. Finding an agent that specializes in this area is important so that no mistakes are made.
Source: georgiamedicaresupplements.com

Coventry Medicare: Advantra (HMO

Whether you are an employer, health care provider, interested in enrolling, or already a member, our goal is to provide you with valuable and convenient online resources and information. Come explore the ways in which we can help you take charge of your Medicare Advantage coverage.
Source: coventryhealthcare.com

2015 Georgia Medicare Part D Prescription Drug Plan Highlights www.Q1Medicare.com

Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3720 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2015, ALL formulary generics will have at least a 35% discount and ALL brand drugs will have at least a 55% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
Source: q1medicare.com

Texas Medicare Part D & Medicare Advantage Plans

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Choosing a Texas Medicare Part D plan that fits your circumstances is very important as there are many plans to choose from. Texas Medicare Part D plans are offered by private insurance companies so there are plans with different deductibles, copays and premiums. Before you choose a Medicare Part D plan in Texas you should determine your annual out-of-pocket expenses for prescription medications. Make sure the Texas Medicare Part D plan you select covers all of your prescriptions. You should consider the copays, deductibles and premiums of each plan to determine which Medicare Part D plan offers the most savings. You can compare Texas Medicare Part D plans by using the PlanPrescriber Medicare Part D plan comparison tool to find a plan in Texas that works for you.
Source: mytexasmedicare.net

Medicare Supplement and Medicare Advantage Plans in Texas

From Houston to Plano, San Antonio to Corpus Christi, Dallas/Ft. Worth to Austin, El Paso to Arlington, Amarillo, Beaumont, Brownsville, Denton, Frisco, Garland, Irving, Laredo, Lubbock, Pasadena or Waco it is important that you find the medicare coverage that fits your life and your lifestyle. We feel that the best care is received when you have your choice of Doctors, and you and your Doctor make your medical decisions. Medigap plans in Texas are available with no medical underwriting during your initial enrollment period. This is when you become eligible for Medicare Part B. You may however, apply to a company and fill out the medical underwriting questions at any time. We are pleased to introduce our Texas Medicare Supplement Comparison Quoting System. It is a very simple process where you enter a few bits of information and then we will quote all of the medicare supplement plans offered by several companies. The companies that we select to quote are based on their strong reputations and competitive pricing. Some of the companies that we represent are: Aetna, BlueCross BlueShield of Texas, Combined Insurance, Equitable Life, Heartland National, Omaha Insurance Company, Standard Life & Casualty, UCT, United American and UnitedHealthcare
Source: medicare-texas.net

Medicare Supplement Quotes in Texas

First, we hope this website provides you a better understanding of what is about to happen like the fact that regardless of what you do or don’t do most if not all seniors automatically become enrolled in Part A of Medicare, this is the part of Medicare that provides your basic coverage. Also you should know that you should automatically have eligibility in Part B of Medicare, that’s the part that provides out patient benefits like doctor charges and testing. There is a small fee for Part B that is deducted from your Social Security benefits. We have provided more detailed information on Texas Medicare Eligibility to hopefully assist in understanding more about it. 
Source: medicareinsurancetexas.com

Medicare.gov Physician Compare Home Page

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The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare.gov: the official U.S. government site for Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Patients’ Access to Physicians: A Synthesis of the Evidence

Nationally, patient and physician surveys and Medicare’s administrative data show that most Medicare patients enjoy good access to physicians and most physicians are accepting new Medicare patients.  Moreover, survey findings reveal that Medicare beneficiaries and adults with private insurance report similar access to physicians. While the majority of Medicare beneficiaries report having a usual source of care and do not forego needed physician visits, certain subgroups of Medicare beneficiaries have higher rates of access problems that warrant close attention. These include beneficiaries with no supplemental insurance or Medicaid, beneficiaries under age 65 living with a permanent disability, beneficiaries in fair and poor health, beneficiaries with four or more chronic conditions, and beneficiaries with lower incomes. For the most part, however, even among these subgroups, most do not report significant problems securing access to medical care when needed. Physician surveys and Medicare data tell a complementary story to the patient surveys.  Overall 91 percent of physicians report taking new Medicare patients—comparable to the rate for new private non-capitated patients. About 1 percent of physicians have formally opted-out of the Medicare program to contract privately with all their Medicare patients, with psychiatrists comprising the largest share.  Factors that influence physician decisions about acceptance of new patients can be strongly influenced by local health market circumstances that cannot be ascertained from state-level data.  Further research is needed at a more local level to understand how access is affected by other factors including provider supply, other insurer interactions, changes in group practice dynamics, and patient demand for medical services. Survey instruments could be improved to determine if doctors in open practices access some or all new patients, by type of insurance. While this paper focuses mostly on physicians, the number of other health professionals who provide care to Medicare patients—such as nurse practitioners and physician assistants—has grown rapidly over the past decade.
Source: kff.org

Database: How much Medicare pays doctors

For the first time, the government is releasing detailed data about medicare payments to doctors, revealing what procedures doctors performed and what they were paid. The trove of billing records shows that thousands of physicians made more than $1 million each from Medicare in 2012. Dozens billed for more than $10 million. Billing for a large amount is not necessarily a sign of wrongdoing.
Source: washingtonpost.com

Bureau of Health Facility Licensing, Certification and Resident Assessment

Posted by:  :  Category: Medicare

If you would like more information about the bureau please click on the “Bureau Info.” button to the left.  Report card information for a specific facility is available by clicking the “Report Card” button.
Source: utah.gov

Utah.gov: The Official Website of the State of Utah

Collaborate provides a venue for citizens to submit data visualizations, mobile apps, maps, location information, photos, videos, widgets, and blogs that would be of interest to Utah.gov and it’s users.
Source: utah.gov

Utah Department of Health

The mission of the Division of Family Health and Preparedness is to assure care for many of Utah’s most vulnerable citizens. The division accomplishes this through programs designed to provide direct services, and to be prepared to serve all populations that may suffer the adverse health impacts of a disaster, be it man-made or natural.
Source: utah.gov

Medicare Advantage Payment Reductions Are Good News for Medicare 

Posted by:  :  Category: Medicare

Thus, as cost growth in Medicare slows, payment increases to MA plans also slow, to reflect actual costs.   This slower growth in Medicare costs is good news for Medicare financing and the federal budget.   Some policymakers, along with the insurance industry, call for MA payment rates to be held "flat" by maintaining current funding levels, or even increased.  Not only would keeping MA payment levels flat or increasing such payment contradict current law, private insurers that choose to offer Medicare plans should not be insulated from market forces that are reducing the rate of growth of Medicare and health care costs. To do otherwise would give preferential treatment to private plans by continuing to overpay them – extra costs that would continue to be subsidized by the majority of Medicare beneficiaries who choose not to enroll in MA plans.
Source: medicareadvocacy.org

How to Replace a Lost Medicare Card

Posted by:  :  Category: Medicare

While you might not really need to replace a lost Social Security card, as a Medicare beneficiary, your red, white, and blue Medicare card is the most piece of information you own. Your Medicare card is proof that you are enrolled in Original Medicare and will usually be needed in order to receive medical services or medications covered by Medicare.
Source: about.com

How to Replace a Lost Medicare Card (3 Steps)

Regardless of which method you choose, you’ll provide your Social Security number, your name as it appears on your Social Security card and your date of birth. No other documentation is required. When using the automated telephone service, you will be required to select menu options to direct your call to the request for a replacement Medicare card option. Whether you request a card online, by phone or in person, it takes approximately 30 days to receive a replacement Medicare card in the mail.
Source: ehow.com

Medicare Card: Applying for a New Medicare Card and Replacing a Lost Medicare Card

Once you have enrolled in the Medicare program, your red, white, and blue Medicare card should arrive in the mail about three months before your coverage begins. For U.S. citizens and legal permanent residents approaching their 65th birthday, enrollment in Medicare could be automatic. This happens if you receive Social Security Administration (SSA) benefits or Railroad Retirement Board (RRB) benefits. In these cases, you are enrolled in Medicare Part A beginning on the first day of the month in which you turn 65, and your card should arrive three months prior to this.
Source: planprescriber.com

Order a Medicare Replacement Card Online

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Source: medicarecard.com

Medicare.gov: the official U.S. government site for Medicare

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The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

More Medicare Information

If you live in Puerto Rico you will not receive Medicare Medical Insurance (Medicare Part B) automatically. You will need to sign up for it during your initial enrollment period or you will pay a penalty. To sign up, please call our toll-free number at 1-800-772-1213 (TTY 1-800-325-0778). You also may contact your local Social Security office. You can find your local Social Security office by using our Office Locator.
Source: ssa.gov