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

Posted by:  :  Category: Medicare

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Source: medicare.gov

Provider Enrollment Forms

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

New York Medicare Part D Plans

Posted by:  :  Category: Medicare

Medicare drug plans cover a portion of all covered prescription drug costs after the enrollee has paid their annual drug deductible. However an enrollee’s actual drug costs will depend on their drug plan’s cost-sharing requirements for each drug tier, whether they use a preferred pharmacy in the plan’s network, whether their drugs are listed in the plan’s formulary (and if so, the tier in which the drugs are listed), and whether the enrollee is eligible for income-based subsidies. Using CMS data HealthPocket found that:
Source: healthpocket.com

AARP Medicare Supplement Insurance Plan F

At Plan Medicare we also know how important it is to get personal. We give every client the attention they need to choose, understand, enroll and maintain the best Medicare coverage. Our licensed agents manage everything from: eligibility, paperwork, liaising with insurance providers, billing and payment questions, and staying up to date on policy changes. We are here to help our clients get the most out of their coverage.
Source: planmedicare.com

Comprehensive Medicare Supplement Insurance in New York!

That’s where we come in. Medigap360, the 190th fastest growing private company in America in the annual Inc. 500 list last year, has been in this industry for nearly three decades now and we’ve helped thousands of seniors find the perfect Medicare Supplement Insurance Plans at the best prices. We’ve worked with every major Medicare Supplement Insurance provider in the country. We’ve done the research and we know where to find the most comprehensive Medicare Supplement Insurance Plans with the most affordable rates.
Source: medicaresupplementsnewyork.com

New York Medicare Fraud Lawyer

These cases can be extremely complex and you must have an attorney that understand how these cases work. Mr. Discioarro has also appeared on Fox News, ABC, CNN, Associated Press, New York Times, Daily News, The New York Post, and other publications discussing a veriety of criminal issues.You do not need to face these charges alone. Contact the Law Offices of Michael S. Discioarro, LLC and let us put our experience to work for you. Call our confidential hotline at 917-519-8417.
Source: newyorkmedicarefraud.com

Calculating Medicare Fee Schedule Rates

Posted by:  :  Category: Medicare

MPPR is a per-day policy that applies across disciplines and across settings. For example, if an SLP and a physical therapist both provide treatment to the same patient on the same day, the MPPR applies to all codes billed that day, regardless of discipline. Under MPPR, full payment is made for the therapy service or unit with the highest practice expense value (MPFS reimbursement rates are based on professional work, practice expense, and malpractice components) and payment reductions will apply for any other therapy performed on the same day. For the additional procedures provided on the same day, the practice expense (i.e., support personnel time, supplies, equipment, and indirect costs) of each fee will be reduced by 50% (effective April 1, 2013) for Part B services in all settings. The professional work and malpractice expense components of the payment will not be affected. ASHA has developed three MPPR scenarios to illustrate how reductions are calculated.
Source: asha.org

Aetna to cut pathology reimbursement to 45

In 2011, Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume and/or high-expenditure lab tests. Medicare could have saved $910 million, or 38 percent, on these lab tests if it had paid providers at the lowest established rate in each geographic area. State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates, although most pay less. However, unlike Medicare, FEHB programs incorporate factors such as competitor information, changes in technology used in performing lab tests, and provider requests in their payment rates. Some State Medicaid programs and FEHB plans required copayments for lab tests, which, in effect, lowered the costs of lab tests for the insurer.
Source: pathologyblawg.com

How Medicare, Other Payers Determine Physician Reimbursement Rates

Do you know how Medicare and other payers determine reimbursement rates? Most physicians don’t. Reading this summary of the history and elements will take less than three minutes, and will make you better informed than most. History. The resource-based relative value scale (RBRVS) was introduced in the Omnibus Budget Reconciliation Act of 1989. The intent was to create a uniform and objective payment system to address the large payment disparities produced under the traditional usual, customary, and reasonable (UCR) standard. The new scheme was adopted over a five-year transition period.  NOTE: The sustainable growth rate (SGR) was part of the Balanced Budget Act of 1997 and is separate. Relative Value Units (RVUs) and CPT codes. Three RVUs are assigned to each CPT code: Physician work RVU: A relative measure of the time, skill, training, and intensity required to provide a specific service The goal is for each CPT code to be reviewed at least every five years in order to make adjustments to reflect changes in the components of the service. Practice expense RVU: Addresses expenses associated with providing the service. The direct costs (staff allocation, supplies, and equipment) of the service are calculated; indirect costs (any costs of operations not directly involved in providing the service) are allocated. A new method of calculating practice expense was fully implemented in 2010, after a transition period. Malpractice RVU: Costs associated with professional liability expenses. Who sets RVUs? CMS sets RVUs based upon the recommendations of the Specialty Society Relative Value Scale Update Committee (RUC). The RUC is made up of 29 physicians, 23 of whom are nominated by professional societies. Almost all are specialists. CMS is not bound to accept either the professional society nominees or the RUC’s recommendations, but it has historically approved more than 90 percent of RUC recommendations. The process has been criticized for a lack of transparency. There are also those who argue for more representation by primary-care providers, private insurers, and employee health plan purchasers. Geographic Practice Cost Indices (GPCI). A GPCI is calculated, by CMS, for each of the RVU components. The GPCIs are reviewed every three years and attempt to take into account the different costs associated with different areas of the country. Conversion Factor (CF). The CF translates RVUs and GPCIs into actual dollars. It is updated annually according to a formula specified by statute. CMS may not, by statute, increase its total annual budget by more than $20 million. If shifts in the RVUs would increase CMS’ budget by more than $20 million, the CF is used to achieve, essentially, budget neutrality. Congress may override the CF formula and regularly does. Non-Facility Payment Amount. A non-facility is a freestanding physician’s office, as well as other freestanding settings. Inpatient facilities, hospital outpatient clinic settings, and off-site hospital-owned locations are considered “facilities.” The payment for each CPT code in a non-facility is calculated as follows: Payment = [(Physician Work RVU X Work GPCI) + (Non-Facility Practice Expense RVU X Practice Expense GPCI) +     (Malpractice RVU X Malpractice GPCI)] X (Conversion Factor, adjusted for budget neutrality) 2014 Payment Changes. CMS released the finalized payment rates and policies for 2014 on Nov. 27, 2013. The total payments under the fee schedule are projected to be $87 billion. The largest increases go to psychiatry, clinical psychologists, and clinical social workers, as well as other providers of mental health services. There was also an aggregate increase in physician work RVUs and a corresponding decline in practice expense RVUs. Beginning in 2015, CMS will establish separate payments for managing a patient’s care outside of face-to-face contact. Private Payer Reimbursement. Most, if not all, private payers tie their reimbursement rates to Medicare’s. Contrary to widespread perception, private payers often reimburse at rates lower than Medicare. As intricate as this may seen, these are just the basics. Bonuses and penalties for quality, patient satisfaction, eRX, and meaningful use are topics for another day.
Source: physicianspractice.com

CMS Announces New Medicare Reimbursement Rates for 2014

The proposed rule would increase IPPS operating rates by 0.8 percent after accounting for inflation and other adjustments required by the law.  This proposed increase also reflects a proposed temporary reduction of 0.8 percent to implement the American Taxpayer Relief Act’s requirement to recoup overpayments from prior years as a result of a new patient classification system that better recognizes patient severity of illness.  CMS is also proposing an additional 0.2 percent reduction to offset projected spending increases associated with proposals regarding admission and medical review criteria for inpatient services.  CMS projects that LTCH PPS payments would increase by 1.1 percent, or approximately $62 million, in FY 2014.
Source: insidearm.com

Medicare Coverage of Speech

This area of the Reimbursement site provides information on the major aspects of Medicare related to audiology and speech-language pathology services, including Medicare coverage guidelines and reimbursement rates.
Source: asha.org

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

Posted by:  :  Category: 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 Plans for Different Needs

Your health is important. Find a UnitedHealthcare Medicare Advantage plan or Medicare prescription drug plan that may be right for you before Open Enrollment ends December 7. With a Medicare Supplement Insurance plan* you may apply at any time throughout the year.  
Source: uhcmedicaresolutions.com

Best Medicare Supplement Insurance Quotes

Every Medicare supplemental insurance plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental insurance plan identified by letters A through N. Each modernized Medicare supplemental insurance plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Contact Information and Websites of Organizations for Medicare

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Source: medicare.gov

Coventry Medicare: Dental Providers

Posted by:  :  Category: Medicare

As you’ve come to expect with Coventry Health Care the foundation of our dental program is disease prevention and maintaining optimal health. As a member, you will receive courteous and accurate responses from front-line staff. Customer support teams can help you with questions about claims, finding a provider or resolving an issue. Please carefully read the information below to determine which provider search to use.  Use the applicable provider search for your plan to find dentists in your local area.
Source: coventryhealthcare.com

BCBS of IL Provider Finder

Blue Cross Community MMAI (Medicare-Medicaid Plan) is provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Enrollment in HCSC’s plan depends on contract renewal.
Source: bcbsil.com

Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

The establishment of the participating provider program in Medicare instituted multiple incentives to encourage providers to accept assignment for all their patients and become participating providers.  For example, Medicare payment rates for participating providers are 5-percent higher than the rates paid to non-participating providers.  Also, participating providers may collect Medicare’s reimbursement amount directly from Medicare, in contrast to non-participating providers who may not collect payment from Medicare and typically bill their Medicare patients upfront for their charges.  (Non-participating providers must submit claims to Medicare so that their patients are reimbursed for Medicare’s portion of their charges.) Participating providers also gain the benefit of having electronic access to Medicare beneficiaries’ supplemental insurance status, such as their Medigap coverage. This information makes it considerably easier for providers to file claims to collect beneficiary coinsurance amounts, as well as easing the paperwork burden on patients.  Additionally, Medicare helps beneficiaries in traditional Medicare seek and select participating providers by listing them by name with their contact information on Medicare’s consumer-focused website (www.Medicare.gov).
Source: kff.org

Raising the Age of Eligibility for Medicare to 67: An Updated Estimate of the Budgetary Effects

Posted by:  :  Category: Medicare

Outlays for Medicare would be lower under this option because fewer people would be eligible for the program than the number projected under current law. In addition, outlays for Social Security retirement benefits would decline slightly because raising the eligibility age for Medicare would induce some people to delay applying for retirement benefits. One reason is that some people apply for Social Security at the same time that they apply for Medicare; another reason is that this option would encourage some people to postpone retirement to maintain their employment-based health insurance coverage until they became eligible for Medicare. CBO expects that latter effect would be fairly small, however, because of two considerations: First, the proportion of people who currently leave the labor force at age 65 is only slightly larger than the proportion who leave at slightly younger or older ages, which suggests that maintaining employment-based coverage until the eligibility age for Medicare is not the determining factor in most people’s retirement decisions. Second, with the opening of the health insurance exchanges, workers who give up employment-based insurance by retiring will have access to an alternative source of coverage (and may qualify for subsidies if they are not eligible for Medicare). This option could also prompt more people to apply for Social Security disability benefits so they could qualify for Medicare before reaching the usual age of eligibility. However, in CBO’s view, that effect would be quite small, and it is not included in this estimate.
Source: cbo.gov

Medicare Eligibility Requirements

In purchasing a Medigap Supplemental Insurance Policy, getting enrolled by the initial enrollment period is very crucial. If you apply during the IEP, by law, you are guaranteed that all insurers selling Medigap coverage in your state must offer you all the Medigap Supplemental Policy coverage plans that they sell. In addition, this guarantees, by law, that the insurance rate premiums offered to you will be the same as a person considered to be in good health. This applies, regardless of the fact that your current or past health history may not have been good or you have ongoing health issues.
Source: medicare.net

Medicare Age Requirement (with Pictures)

As you near retirement, you may want to look into getting Medicare coverage. Medicare is the health-care plan provided by the U.S. government to senior citizens and can cover medical, hospital and prescription drug expenses. Medicare is available in three parts: Part A, Part B and Part D. Part A is available at no cost and covers hospital stay expenses. Part B and Part D cover medical care and prescription drugs respectively. You may need to pay a premium, regardless of your age for Part B and Part D.
Source: ehow.com

Medicare Eligibility Requirements

Note: You can qualify for Medicare on your spouse’s work record if he or she is at least age 62 and you are at least age 65. You also may qualify on the work record of a divorced or deceased spouse. Following the Supreme Court’s ruling on the Defense of Marriage Act in June 2013, people in same-sex marriages may qualify on their spouse’s work record if they live in the state where they were wed or in another state that recognizes same-sex marriage, or if they are civilian or military employees of the federal government. It’s currently unclear whether same-sex couples outside of these categories have the same rights — but if you’re in this position, you should apply anyway.
Source: aarp.org

Medicare Eligibility Rules

If you are age 65 and currently receiving Social Security or Railroad Retirement Benefits, you are eligible for Medicare and you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. In addition, Part B does require payment of a monthly premium of $104.90, barring certain exceptions, for individuals enrolling in Part B January 1, 2015 or later. These premiums can change on an annual basis.
Source: planprescriber.com

Medicare Eligibility and Enrollment

re already getting Social Security checks, you will be automatically enrolled in traditional Medicare. You’ll get your Medicare card three months before your 65th birthday. The benefits kick in on the first day of the month of your 65th birthday. Traditional Medicare, which is also called original Medicare, includes Medicare Parts A and B. Part A is hospital coverage. Part B covers doctor visits, lab tests, and other outpatient services.
Source: webmd.com

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

Your health is important. Find a UnitedHealthcare Medicare Advantage plan or Medicare prescription drug plan that may be right for you before Open Enrollment ends December 7. With a Medicare Supplement Insurance plan* you may apply at any time throughout the year.  
Source: uhcmedicaresolutions.com

UnitedHealthcare Medicare Solutions

In your journey to keep yourself healthy, you want to be sure your health plan and your local physician are with you every step of the way. UnitedHealthcare and North Texas Specialty Physicians provide coordinated care and wellness programs that work together to keep you healthy. Click below to learn more!
Source: uhcmedicaresolutions.com

Social Security Tax / Medicare Tax and Self

Posted by:  :  Category: Medicare

The United States has entered into social security agreements with foreign countries to coordinate social security coverage and taxation of workers employed for part or all of their working careers in one of the countries. These agreements are commonly referred to as Totalization Agreements. Under these agreements, dual coverage and dual contributions (taxes) for the same work are eliminated. The agreements generally make sure that social security taxes (including self-employment tax) are paid only to one country. You can get more information on the Social Security Administration’s Web site.
Source: irs.gov

What is Medicare Tax? definition and meaning

Tax deducted from the wages of every legally working American that is used to pay for the Medicare program provided to individuals over the age of 65. This is typically another line item included on an employee’s paystub. At the end of year, the employer will provide the employee with a W-2 and this will include the total amount deducted from the individual’s paycheck for the Medicare tax. The tax was implemented under the Federal Insurance Contributions Act.
Source: investorwords.com

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

Medicare Supplement Plan F may offer expansive coverage, but it does not cover everything. Under Plan F, beneficiaries are still required to pay their Medicare Part B premium payments each month. Additionally, it is possible to have Medicare Part A without a monthly premium if the beneficiary has worked and paid Social Security taxes for at least 40 calendar quarters (10 years). Otherwise, a monthly premium for Part A coverage is also required. These costs are not covered under Medicare Supplement Plan F.
Source: ehealthinsurance.com

Medicare Supplement Plan F

* A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
Source: bcbsil.com

Tufts Health Plan Medicare Preferred

Posted by:  :  Category: Medicare

In 2016, our HMO plans earned 5 out of a possible 5 Stars by the Center for Medicare and Medicaid Services. This rating combines the scores our plans received for the various medical and/or prescription drug services our plans offer.
Source: tuftsmedicarepreferred.org

SPIRAL:Patient Information by Topic

SPIRAL provides access to the following patient information documents created by non-profit health agencies and organizations. For information on how information is selected for inclusion, please see the SPIRAL Selection Guidelines. All documents are intended for public use and may be distributed for not-for-profit purposes.
Source: tufts.edu