Medicare Fraud Reporting Center

Posted by:  :  Category: Medicare

Medicare Whistleblowers are typically healthcare professionals who are aware of hospitals, clinics, pharmacies, Nursing Homes, Hospices, long term care and other health care facilities that routinely overcharge or seek reimbursement from government programs for medical services not rendered, drugs not used, beds not slept in and ambulance rides not taken. If you have information about a person or a company that is cheating the Medicare program (or any other government run healthcare program), you may be able to collect a large financial reward for reporting it here.
Source: medicarefraudcenter.org

How to Report Medicare & Disability Fraud in Florida

Call the Florida health department. Because the health department oversees Medicare, Medicaid and disability services for Florida residents, you may report fraud in these areas to state authorities, who will work with federal authorities to investigate your claim. The Florida Department of Health notes that its disability office is the third largest in the country, handling 6 percent of all disability claims in the U.S. The health department maintains a list of all regional offices with full contact information; to report fraud in your area, call your nearest regional office with details of the fraudulent activity. Depending on the type of fraud, state authorities may ask you to complete a specific form or share your claim with federal authorities or law enforcement staff.
Source: ehow.com

Help fight Medicare fraud

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Source: medicare.gov

Welcome to Your Texas Benefits

Posted by:  :  Category: Medicare

You can fill out this screening form to find out which benefits and support services you might be able to get. At the end of the form, you can decide if you want to log in and: (1) apply for benefits, and (2) send your form to support programs and ask them to contact you about their services.
Source: yourtexasbenefits.com

Health and Human Services Commission

HHSC is seeking candidates for the Texas Medicaid Electronic Health Record (EHR) Incentive Program Ad Hoc Review panel. Ideal candidates would be familiar with EHR systems and the EHR Incentive Program. Responsibilities include reviewing materials related to the processes regarding Medicaid EHR incentive payments. Panel members will participate in discussions and provide recommendations to HHSC regarding the materials reviewed. Work is estimated to take up to 5 hours a month and meetings will be conducted by web or phone. All positions are voluntary. The term for serving on the panel is one year. Interested candidates should complete and submit an application.
Source: tx.us

TEXAS MEDICAID APPLICATION

In order to participate in Medicaid, federal law requires states to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). States set individual eligibility criteria within federal minimum standards. States can apply to the Centers for Medicare & Medicaid Services (CMS) for a waiver of federal law to expand health coverage beyond these groups. Medicaid is an entitlement program, which means the federal government does not, and a state cannot, limit the number of eligible people who can enroll, and Medicaid must pay for any services covered under the program. In December 2011, about one in seven Texans (3.7 million of the 25.9 million) relied on
Source: texasmedicaidapplications.com

Enroll in Medicaid or CHIP any time of year

If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.
Source: healthcare.gov

Asset Protection Specialists Massachusetts

Posted by:  :  Category: Medicare

We specialize in MA nursing home medicaid spend down planning helping elders to preserve their home, their life savings and other assets. We have appeared with Jordan Rich of WBZ News Radio 1030 in variety of seminars on the topic of Senior Asset Protection.
Source: commadvisory.com

Massachusetts Medicaid (MassHealth)

B.     The Working-10-Hour way.  Regulations for MassHealth state (see page 10 in booklet) that, if a disabled applicant is currently working 10 hours per week, then this will qualify him/her for MassHealth CommonHealth without that person having to pay the one-time deductible.   A “working 10 hour letter” would need to be submitted with the application (or soon thereafter). The letter needs to be written by the disabled person’s employer and must include, at a minimum, these 3 important information pieces:  disabled person’s name and SSN, number of hours per week worked (must be at least 10 hours/week), rate of pay (must be at least $1.00 per hour), and letter must include the type of work performed.  The letter must be signed by the employer and include employer’s phone number.
Source: sh-sci.org

MassHealth: Medicaid in Massachusetts

Submitting a MassHealth application to help cover nursing home costs without elder law advice can often be a bad idea. I often describe the MassHealth application process for nursing home care as “guilty until proven innocent.” MassHealth applications are closely scrutinized, with a lookback period of 5 years on all financial records. Gifts, below-market sales and unexplained financial transactions can cause problems; any unexplained or poorly-explained expenditure can be treated as a disqualifying transfer of assets, delaying MassHealth eligibility at a time when there are no remaining funds to pay for nursing home care. Trusts are often rejected without explanation. The application process can take several weeks or even months, while the MassHealth eligibility worker keeps asking questions and demanding further verifications.
Source: masshealth.info

2015 Medicaid Nursing Home Care Numbers for Massachusetts

You can download and read the 2015 Medicaid Nursing Home Care Coverage Figures which include definitions of the Community Spouse Resource Allowance (CSRA), the Minimum Monthly Maintenance Needs Allowance (Minimum MMNA), and the principal residence equity allowance. These regulations help to protect the spouse living at home. State and federal laws come into play, along with thousands of Medicaid regulations: regulations that determine whether you are financially eligible regulations that say who can be an authorized representative who signs a MassHealth application regulations on who can file an appeal if your application gets denied. In addition to the regulations, MaasHealth has Eligibility Operations Memos that talk about whether you must privately pay for nursing home care from your own funds.
Source: masshealthhelp.com

The MassHealth (Medicaid) Lawyer

The MassHealth Planning & Elder Law blog is regularly updated to provide you with the most up to date news and information affecting Massachusetts seniors and the long-term care planning options available under Medicaid. If you have any questions or cannot find the information you are looking for in our article database, please ask us or suggest a new article topic using the submission form on the right. Also, you can sign up to receive our monthly newsletter which includes a summary of the previous month’s articles from our estate planning & probate blog and our MassHealth planning & elder law blog, as well as upcoming events and offers.
Source: mamedicaidlawyer.com

When Medicaid in Massachusetts Will Pay for Long

If your income is above the limit but you need help with nursing home costs, you still might be able to qualify for Medicaid if you’re already paying for a nursing home or have other significant medical expenses. A MassHealth worker will determine your excess monthly income to see if you qualify. Excess monthly income is income left over after subtracting Medicare or other health insurance premiums, a personal needs allowance, and any spousal or family maintenance needs allowances (more about that below). That amount, multiplied by six, is the “deductible” that you must meet in a six-month period to be eligible for MassHealth. You must show proof that your nursing home home costs or medical expenses equal the required deductible amount. Once you show medical expenses that equal your deductible, then you are eligible for MassHealth for the entire six-month period.
Source: nolo.com

Medicare Advantage Rates & Statistics

Posted by:  :  Category: Medicare

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

Medicare and the Mayo Clinic

The double irony is that earlier this year Mayo itself came out against the House health bill as offering too little cost-saving reform. And, six months later, the truth is that neither bill in Congress includes the kind of cost-saving innovations that would lead to more Mayos. Instead, the highly touted insurance "exchanges" will essentially import Medicare’s rules. Mr. Orszag and the Obama whiz kids have settled for "pilot programs" and cost-saving quarter measures because Congress doesn’t want to give up political control over government health payments.
Source: wsj.com

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

National Provider Identifier Standard (NPI)

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
Source: cms.gov

Unique Physician Identification Number (UPIN) Directory

The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and some non-physician practitioners who are enrolled in the Medicare Program. The data elements in the file (UPIN, full name, specialty, Physician License State Code, zip code, Medicare provider billing number and State) are extracted from the UPIN Database and are approved for public release in the Centers for Medicare & Medicaid Services (CMS) System of Records. The file is updated quarterly with updates being available usually by April 15, July 15, October 15, and January 15. Each update file is considered as a replacement file.
Source: cms.gov

How to Find a Medicare Number

Look at your social security card. Your social security number is the first part of your Medicare number for part A and B benefits. The second part is the letter A or B, depending on which benefit you are needing the number for. Part A is inpatient hospital benefits and Part B is outpatient medical benefits. For example, if your social security number is 111-22-3333, then your Medicare number for Part A benefits is 111-22-3333-A. If you do not have a social security card or your Medicare card, contact your local SSA office for a list of documents required for obtaining a replacement card.
Source: ehow.com

How do you look up your Medicare number?

A Medicare number includes a person’s social security number followed by a small code that consists of letters or letters with numbers depending on various factors. It is also called a Medicare claim number on documents from the provider. Because the number is primarily made up of a person’s social security number, it is not easy to look it up if lost or forgotten.
Source: ask.com

Medicare.gov Physician Compare Home Page

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Source: medicare.gov

Difference between the Medicare Provider Numbers

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

What Is Medigap vs Medicare Advantage?

Posted by:  :  Category: Medicare

Medigap works along side your original Medicare helping to pay Medicare covered expenses that are not paid for by Medicare due to deductibles and coinsurance.  You will pay a premium for a Medigap plan but your out of pocket exposure in the event of a large claim will be less than with a Medicare Advantage plan Medicare Advantage takes the place of Medicare.  While you are still in the Medicare system and protections, responsibility for benefits and claim management are provided by the insurance company, not Medicare. You cannot have both a Medigap and a Medicare Advantage Plan since Medicare Advantage has different deductibles and copay’s than Medicare.  Premiums are much less than Medigap plans but you will have more out of pocket exposure in most cases.
Source: insurancelibrary.com

Medigap Vs. Medicare Advantage: Which Is Better?

Medicare has four basic parts – A, B, C and D. If you’re unfamiliar with how they work, read Medicare 101: Do You Need All 4 Parts? Taken together, Parts A (hospital care), B (doctors, medical procedures, equipment) and D (prescription drugs) provide basic coverage for Americans 65 and older. What’s relevant for this article is what these parts don’t cover – deductibles, co-pays and other medical expenses that could wipe out your savings should you become seriously ill. That’s where Part C comes in. Also known as Medicare Advantage, it’s one of two ways to protect against the potential high cost of an accident or illness. Here’s what could happen.
Source: investopedia.com

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. All plans, by law, have annual limits on out-of-pocket costs. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Medigap Plan F Rates, Coverage, and Information

Posted by:  :  Category: Medicare

Medigap Plan F, also called Medicare Supplemental Insurance Plan F, is the most popular Medigap option as it is one of only two plans that cover Medicare Part A and B excess charges.  Once a Medicare enrollee reaches a certain cap on their health coverage, they are responsible to cover all remaining costs for medical services.  Medigap Plan F covers the cost of medical services should you exceed your allotted limited that Medicare covers.
Source: medicaresupplementalinsurance.com

Medicare Supplement Plan F

As with all of the Medigap Plans, there is no network. You may visit any doctor, specialist or hospital in the country that accepts Medicare and use your Medicare Supplement Plan F, regardless of which company you obtain your coverage from. Deciding on which Medigap plan to choose involves a few basic factors, including: • How often you visit your doctor • Your overall health • If you can afford the monthly premium • Whether you want to have additional out-of-pocket expenses in trade for a lower monthly premium Because Medicare Supplement Plan F offers the most comprehensive coverage from all the plans, it also has the highest premiums. For those who want all of the gaps in Medicare paid and never want to receive a medical bill, Plan F is a great choice. It is wise however, to check premiums and coverage from other plans such as a Medigap Plan G and Medicare Supplement Plan N. These plans typically have a lower premium and outstanding coverage after you pay a small annual deductible (Part B) and possibly some co-pays. Click HERE to compare plans and Medigap Rates from the top companies, and get expert advice from highly qualified agents if you choose.
Source: medigapv.com

Find The Best Rate For Medicare Plan F With MediGap Advisors

"Dawn was very responsive, knowledgeable, and helpful! The process was pleasant and painless. As for why we chose MediGap Advisors, I found you on the internet and after talking with Dawn, the decision was easy. You should know that I am an insurance agent, but do not offer Med Sups. I do have several friends who do, but I chose to work through Dawn anyway. I think that should give you some comfort that you have a solid agent representing your company."
Source: medigapadvisors.com

Medicare Supplement Plan F

* A benefit period begins on the first day you receive service 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. **This high deductible plan pays the same or offers the same benefits as Plan F after you have paid a calendar year $2110 deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $2110. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.
Source: medigap360.com

DiabeticSupplies.com: Diabetic Testing Supplies to Control Diabetes

Posted by:  :  Category: Medicare

   Shop      Billing Your Plan for Diabetic Supplies      Diabetes 101      Meters 101      Shop By Brand         
Source: diabeticsupplies.com

North Coast Medical Supply

It was very nice speaking with you few minutes ago. I greatly appreciate the care you are taking for me, and I am sure for all of your other patients are getting the same. In my entire life, I have not come across ANY organization with better customer service than yours. All the praise to you, your colleagues, and the organization. As I mentioned during our conversation, I have passed on the information to a friend who is diabetic. I also very specifically shared my highly positive experience with the system and customer service.
Source: northcoastmed.com

Medicare Coverage for Diabetic Supplies, Drugs and Preventative Screenings

Some beneficiaries elect to receive their Medicare coverage through a private health insurance company rather than the government. This option is known as Medicare Part C, or Medicare Advantage. All Medicare Advantage plans provide the same diabetes coverage as Medicare Part B. In addition, most also provide Part D benefits as part of their health plan. In the event a Medicare Advantage plan does not include this coverage, a beneficiary must purchase a separate prescription drug plan to cover anti-diabetic drugs, insulin and related supplies. Like Part D plans, Medicare Advantage policies can set their own co-payment and coinsurance rates.
Source: diabetesmonitor.com

Medicare Coverage for Diabetes Supplies

As a Medicare patient, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan, a Medicare Managed Care Plan, or a Medicare Private Fee-for-Service plan. These rights and protections are described in your Medicare & You handbook and include the right to appeal any decision about your Medicare services. For more detailed information about your rights and protections, call 1-800-MEDICARE (1-800-633-4227) to get a free copy of the booklet Your Medicare Rights and Protections.
Source: totallydiabetes.com

Medicare: American Diabetes Association®

Some beneficiaries choose Medicare Advantage plans instead of Medicare Part A and B (the “Original Medicare Plan”). A Medicare Advantage Plan is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Because Medicare Advantage plans are private insurance plans, they come in all shapes and sizes. Out-of-pocket costs vary depending on the plan. Most plans offer prescription drug coverage and plans may offer extra benefits that are not covered under Parts A and B (but you may pay extra for them).
Source: diabetes.org

Medical Malpractice Awards, Insurance, and Negligence: Which Are Related?

Posted by:  :  Category: Medicare

We show that malpractice tort awards and thus insurance premiums can vary dramatically for reasons having little or nothing to do with negligence. We reach this conclusion through a novel test of the tort system, in which we compare awards and rates of determination of negligence in the tort system with rates determined by the independent medical board review system. Although board review outcomes are imperfect, they are biased, if at all, against findings of negligence, because physicians will not allow frivolous complaints to result in disciplinary actions. The tort system shows no or even a slight negative correlation with the board review system’s negligence determinations, suggesting that the system is influenced by factors not related to negligence.
Source: manhattan-institute.org

Can Insurance Premiums be reimbursed through a Health/Medical FSA?

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Source: 24hourflex.com

The Average Cost for Medical Malpractice Insurance

Location and claims history also affect premium rates. States with a higher rate of malpractice lawsuits, and states that require heftier insurance plans, will cost more to practice in. California, Florida, and Nevada tend to have higher malpractice insurance premium costs compared to the rest of the nation. A practitioner’s own history of malpractice claims will also affect premiums. The more claims and lawsuits levied against the practitioner, the higher the premiums will be.
Source: ehow.com

Medical cost trend means rising premiums for health insurance

The ACA penalizes hospitals for excessive readmissions and for medical conditions acquired during treatment in hospitals, also called “hospital-acquired conditions” (or HACs). To avoid these penalties, hospitals have increased their focus on preventive health measures and outpatient services. These efforts have helped reduce the amount spent on medical products and services.
Source: marketrealist.com

Medical inflation to hike insurance premiums

“We had revised it (premium) in 2013 and (current) medical inflation which is 14% as per our internal assessment, it is only natural that we increase our premium rates ,” said MS Sreedhar, MD of Royal Sundaram. His company is also working on rationalizing the several mediclaim policies. “For now we have too many mediclaim policies, we are working towards rationalizing the several policies into fewer ones,” he said. Royal Sundaram writes nearly 11% of gross written premium (Rs 1573 crore as of March 2015) from medical policies. “We want the share of mediclaim policies to go up to 25% in 5 years,” Sreedhar said. Standalone medical insurance companies also concur. “As a matter of policy, we keep aligning our policy premium factoring in inflation. It is a continuous and ongoing process where we increase our premium to match the medical inflation. It depends on our several policies and its riders,” said that CMD of Star Health & Allied Insurance Company. He said that medical inflation was rising by 12 to 14% year-on-year. Private sector medical insurer Max Bupa has concluded a hike in premium only last year and therefore has decided to hold on to tariffs, for now. Its Heartbeat, a medical insurance product which was launched last year saw a nominal increase in premium tariff. “To counter the inflation, customers must have an adequate sum insured. It is crucial for customers to weigh the value vs cost proposition when making a purchase related to their health. They should go beyond premiums and look at restrictions that the policy has and evaluate whether it makes more sense to own a policy with lot of restrictions or pay a little extra but have no restrictions in the form of sub-limits,” said Somesh Chandra, COO at Max Bupa who is holding on to price increases now.
Source: indiatimes.com

When Is Medicare Secondary?

Posted by:  :  Category: Medicare

Many seniors who have turned 65 have enrolled in Medicare but continue to work. These seniors might also be covered by a health insurance policy under their family health plan. In this case they have health insurance coverage by more than one insurance carrier. When Is Medicare Secondary? In this instance Medicare will become the secondary insurance carrier and will only be responsible for paying the remainder of the bill. If the bill had been paid in full then Medicare pays nothing and does not need to be notified.
Source: todaysseniors.com

Medicare & Secondary Insurance

Secondary insurance is not the same as supplemental insurance. A secondary insurer could be Medicaid, your employer’s health coverage or your spouse’s workplace coverage, for instance. Supplemental insurance, also called Medigap, is specifically tailored to cover copayments, coinsurance, and deductibles that Medicare doesn’t pay, and possibly services Medicare doesn’t reimburse. Medigap is designed not to cover the same expenses as Medicare.
Source: ehow.com

How Medicare works with other insurance

The BCRC will gather information about any conditional payments Medicare made related to your pending settlement, judgment, award, or other payment. Once a settlement, judgment, award or other payment is final, you or your representative should call the BCRC. The BCRC will get the final repayment amount (if any) on your case and issue a letter requesting repayment.
Source: medicare.gov

Primary & Secondary Insurance Laws

When covered under a group health insurance plan, per Medicare Secondary Payer laws, the group plan is always the primary health insurance. Medicare Secondary Payer laws supersede any insurance rules or state laws concerning coordination of benefits. If Medicare is your primary insurance, any other private supplemental health insurance coverage you purchase would be considered the secondary insurance plan. As a Medicare beneficiary, you must tell your doctors and secondary insurers that you have Medicare coverage.
Source: ehow.com

Medicare Secondary Payer (MSP)

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Source: cahabagba.com