Medicare, Medicaid and Medical Billing

Posted by:  :  Category: Medicare

When a Part A claim is processed by Medicare, Medicare pays the provider directly for the service rendered by the provider. On the other hand, in a Part B claim, who pays depends on who has accepted the assignment of the claim. If the provider accepts the assignment of the claim, Medicare pays the provider 80% of the cost of the procedure, and the remaining 20% of the cost is passed on to the patient. You should recognized that 80-20 breakdown: it’s a classic example of coinsurance.
Source: medicalbillingandcoding.org

Medicare & Medicaid Cost Report l Owner Administrator Forum Seminar

Medicare Training & Consulting, Inc., was founded by Jim Plonsey in the Chicago area. After training Medicare auditors for Blue Cross Association, Jim established a business training Medicare auditors. This lead to doing cost reimbursement seminars for providers, most notably, home health agencies. Medicare Training & Consulting, Inc. has become a leader in providing Owners and Administrators with the reimbursement strategies.
Source: medicareconsulting.net

Medicare Billing Noncovered Services for Skilled Nursing Facilities

Harmony frequently receives calls inquiring about completion of No-Pay Bills and Benefits Exhaust Claims. The SNF is REQUIRED to submit a bill for the Medicare beneficiary for every month of the SNF stay even when no Medicare benefits are payable. The SNF must submit a claim when the patient has exhausted the 100 SNF days. This claim is referred to as a Benefits Exhaust Bill. The SNF must submit a claim when the beneficiary no longer needs Skilled Care. This claim is referred to as a No-Pay Bill. These billing requirements are in place because the Centers for Medicare and Medicaid Services (CMS) will maintain a record of all inpatient services for each Medicare beneficiary whether reimbursable or not. The Medicare Contractor NHIC which covers Jurisdiction 14, recently conducted a Question and Answer session on this topic addressing many commonly asked questions.  We have posted several of our favorites:              
Source: harmony-healthcare.com

Medicare Billing of Audiology Services

For treatment of auditory processing disorders or auditory rehabilitation/auditory training (including speech-reading or lip-reading), 92507, and 92508 are used to report a single encounter with “1” as the unit of service, regardless of the duration of the service on a given day. These codes always represent SLP services. See Pub. 100-02, chapter 15, sections 220 and 230 [PDF, 1.6MB] for SLP policies. These SLP evaluation and treatment services are not covered when performed or billed by audiologists, even if they are supervised by physicians or qualified NPPs. For evaluation of auditory rehabilitation to instruct the use of residual hearing provided by an implant or hearing aid related to hearing loss, the timed codes 92626 and 92627 are used. These are not “always therapy” codes. Evaluation of auditory rehabilitation shall be appropriately provided and billed by an audiologist or speech-language pathologist. Also, these services may be provided incident to a physician’s or qualified NPP’s service by a speech-language pathologist, or personally by a physician or qualified NPP within their scope of practice. Evaluation of auditory rehabilitation is a covered diagnostic test when performed and billed by an audiologist and is an SLP evaluation service covered under the SLP benefit when performed by a speech-language pathologist.
Source: asha.org

ConnectiCare VIP Medicare Insurance

Posted by:  :  Category: Medicare

For prospective members, call us toll-free at: 1-877-224-8221 (TTY/TDD: 1-800-842-9710) Seven days a week from 8 a.m. – 8 p.m. For Member Services, call us toll-free at: 1-800-224-2273 (TTY/TDD: 1-800-842-9710) Seven days a week from 8 a.m. – 8 p.m.
Source: connecticare.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

AHIP Medicare + Fraud, Waste & Abuse Training: Login to the site

Now there’s one single source for both Medicare and Fraud, Waste and Abuse (FWA) training. Our comprehensive online program gives you the background to make informed decisions on Medicare, including plan options, marketing, enrollment requirements, and FWA guidelines.
Source: ahipmedicaretraining.com

Compare Medicare 2016 health plans options in Connecticut , Medicare Advantage plans in Connecticut, Medicare Supplements, What are my 2016 Medicare plan choices in Connecticut, CT, Medicare choices, Medicare Part D, 2016 Connecticut Medicare Plan Choices, choices and Medicare options information for Connecticut Residents, Medicare Advantage plans for 2016, How do I compare Medicare Plans in Connecticut?

Medicare Options, LLC, provides enrollment assistance for senior and disabled residents of Connecticut with their Medicare Health Plan choices including Medicare Medigap plans in Connecticut, Medicare Advantage Plans, Part D prescription drug plans from Aetna, ConnectiCare, United Healthcare, and WellCare in the towns of: Amston, Andover, Avon, Baltic, Berlin, Bloomfield, Bolton, Bozrah, Brandford, Bristol, Burlington, Centerbrook, Cheshire, Chester, Clinton, Colchester, Columbia, Coventry, Cromwell, Deep River, Durham, East Berlin, East Glastonbury, East Haddam, East Hampton, East Hartford, East Killingly, East Lyme, East Windsor, Ellington, Elmwood, Essex, Farmington, Forestville, Glastonbury, Groton, Guilford, Haddam, Hadlyme, Hamden, Hartford, Hebron, Higganum, Ivoryton, Jewett City, Kensington, Killingly, Killingworth, Lebanon Ledyard, Lyme, Madison, Manchester, Marlbourgh, Meriden, Middle Haddam, Milldale, Moodus, Moosup, Mystic, New Britain, New London, Newington, North Branford, Norwich, Old Lyme, Old Mystic, Old Saybrook, Plainville, Plantsville, Poquonock, Portland, Preston, Rockfall, Salem, Saybrook, South Glastonbury, South Lyme, South Windsor, Southington, Terryville, Tolland, Uncasville, Vernon, Wallingford, Waterford, West Hartford, West Mystic, Westbrook, Wethersfield, Windsor, Windsor Locks. We serve the counties of, Hartford County, Tolland County, New London County, Middlesex County, New Haven County, Litchfield County. We are licensed and Certified to advise and enroll medicare recipients on medicare supplements, medicare advantage plans, medicare part D prescription coverage, retirement planning, Long-Term care options, fixed annuities, Reverse Mortgage programs, and eldercare attorney referrals. Consult a tax advisor before making tax related decisions. Consult an attorney specializing in estate planning before making any decisions regulated by federal or state law, such as trusts and wills. MedicareOptions.info provides free information on Medicare options in Connecticut. Medicare Plan Choices in Connecticut for 2014 will help seniors find the best medicare plan for their situation. This site allows people to compare Medicare Advantage Plans in Connecticut. We do not choose which plan is best for beneficiaries, but provide information on Medicare Plans so they can compare their Medicare Choices. Most Medicare Beneficiaries simply want to know, how do I compare Medicare plans in Connecticut. We help them find the best Medicare Plan that suits your particular needs for 2015.
Source: medicareoptions.info

Need help finding the 2016 Medicare Advantage Part D Plan that best meets your needs?

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Source: q1medicare.com

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Supplemental Insurance by 1

 A Medicare Supplement Plan, or Medigap, is a type of medicare health insurance that is sold by private insurance companies and is specifically designed to help you by filling in the “gaps” of Original Medicare. In order to purchase a Medigap plan you must be enrolled in Medicare Part A and B, and you will continue to pay your monthly Part B premium. You would then pay your Medigap premium and as long as your premium gets paid you will have the benefit of guaranteed renewable coverage. What this means is that the insurance company cannot cancel your policy.   There are several different plan types available to consider, but it is important to note that Medigap policies are “standardized.” This means that they are required to abide by the Federal and State laws that are put in place to protect you. The standardized policies must provide you with the same benefits no matter what company sells them and generally the only difference from company to company, if it is the same plan type, is the cost. Many couples would like to be covered under the same policy, but you and your spouse must each purchase your own individual policies. In some instances you might be allowed to purchase a Medicare Supplement plan that is guaranteed issue without any medical underwriting! This means that you cannot be denied coverage. 
Source: youandmedicare.com

Medicare Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Medicare Supplemental Insurance and Supplement Plans

About the author Susan Wright has been working in the insurance and financial services industries for over 20 years. She earned her MBA degree from St. Louis University, and her BA degree from Michigan State University. Susan has been licensed as an insurance agent and FINRA securities broker. In addition, she has earned nine professional designations, including: – CLU (Chartered Life Underwriter) – ChFC (Chartered Financial Consultant) – RHU (Registered Health Underwriter) – REBC (Registered Employee Benefits Consultant) – CSA (Certified Senior Advisor) – CLTC (Certified in Long-Term Care) – CCFC (Certified Cash Flow Consultant) – CSS (Certified Seniors Specialist in Real Estate) – ADPA (Accredited Domestic Partnership Advisor) Learn more about Susan on Google+
Source: medicaresupplementalinsurance.com

Your Medicare Supplemental Insurance Information

Every Medicare Supplemental insurance policy, in order to be designated a “Medicare supplemental” or “Medigap” insurance plan, plan has to follow federal and state laws designed to make the buying process easier for the consumer. Medigap insurance companies can only sell you a “standardized” Medigap policy identified by letters A, B, C, D, F, High-Deductible F, G, K, L, M and N. Each standardized Medigap policy must offer the same basic benefits, no matter what insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies. (You should, however, compare insurance companies on other measures such as customer service and reputation.)
Source: medicaresupplemental.com

What Is Medicare Supplemental Insurance?

To obtain Medigap insurance, the policyholder must be eligible for and enrolled in Medicare parts A and B. Medicare beneficiaries must purchase a single policy as supplemental insurance. Family polices that include coverage for a spouse are not available as Medigap insurance. What is covered in a Medicare supplemental policy differs based on what plans the provider chooses to offer. However, expenses resulting from dental care, vision care and eyeglasses typically are not covered, according to the Centers for Medicare and Medicaid Services. Other exclusions may include long-term and private nursing care.
Source: ehow.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

Affordable Health Insurance in Ohio

Posted by:  :  Category: Medicare

If you need health insurance, now is the time to shop for and enroll in your 2016 coverage. Visit MySummaCare.com to view SummaCare’s Individual & Family Plans. You can enroll from November 1 – January 31, so compare your options and enroll today!
Source: summacare.com

SummaCare Career Opportunities

SummaCare offers a dynamic working environment with opportunities for career development and advancement. In addition to exciting growth opportunities, we offer a comprehensive benefits/compensation package that includes generous medical/dental benefits, 401(k) plan, tuition assistance, non-contributory life insurance and short-term/long-term disability benefits.
Source: summacare.com

Summacare Provider Directory Search

All others, please refer to the back of your ID card to determine the appropriate network and click on its logo below. If you’re not currently a SummaCare member and are unsure which network to search, please check with your Benefits Administrator for more information.
Source: arvatocim.com

SummaCare Medicare Ruby, Summit County, OH Medicare Advantage Plan

SummaCare Medicare Ruby is a Health Maintenance Organization (HMO) health insurance plan for seniors and other people with Medicare living in Summit County, Ohio. It includes all of the benefits of Original Medicare and may include prescription drug coverage and other extras. The primary benefit of an HMO is that the out-of-pocket costs are lower and more predictable than with other types of plans. The monthly premium is
Source: medigapandyou.com

Need help finding the 2016 Medicare Advantage Part D Plan that best meets your needs?

AK  AL  AR  AZ  CA  CO  CT  DC  DE  FL  GA  HI  IA  ID  IL  IN  KS  KY  LA  MA  MD  ME  MI  MN  MO  MS  MT  NC  ND  NE  NH  NJ  NM  NV  NY  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VA  VT  WA  WI  WV  WY
Source: q1medicare.com

Browse Any 2016 Medicare Part D Plan Formulary

- Copay / Coinsurance – These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this “Cost Sharing” category:
Source: q1medicare.com

Electronic Remittance Advice Requests

Posted by:  :  Category: Medicare

Your PCC Partner Practice Management System can receive Electronic Remittance Advice (ERA) from the following payers. ERA is an electronic EOB. Usually ERA is required if you want the payer to send payments to you electronically. ERA is also required if you wish to use Partner’s auto-posting feature.
Source: pcc.com

Medicare Supplement Plan G

Posted by:  :  Category: Medicare

The reason why Medicare Supplement Plan G is more favorable many times is due to the fact that, on average, the Supplemental Plan G costs approximately $20 – $25 less per month than the more comprehensive Plan F, thus saving roughly $240 – $300 per year. With the only difference between Plan G and Plan F being the annual Medicare Part B Deductible ($140 in 2012), the premium savings on Plan G usually outweigh the additional cost of paying for the Plan F, and you can still enjoy virtually all of the same benefits.
Source: medicaresupplementsolutions.com

Medicare Supplement Plan G

* 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: bcbstx.com

Medicare Supplement Plan G

* 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

Medicare Supplement Plan G

The majority of Medicare Supplement plans do not cover Part B excess charges. These are additional charges outside of the Medicare-approved charge. For example, Medicare’s allowed charge for a doctor’s appointment could be $100, but the physician could choose not to accept that amount, and instead charge an additional 15% for the appointment. In this example, Medicare will pay 80% of the allowed charge, sending the physician $80. The beneficiary is responsible for paying not only the remaining $20, but also the excess 15% charge, another $15, making the total out-of-pocket cost $35. Medicare Supplement Plan G covers this excess charge.
Source: ehealthmedicare.com

Medicare Information, Help, and Plan Enrollment

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost-share may change on January 1 of each year.
Source: medicare.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

Medicare Form, Medicare Forms

Aetna Medicare Basic Plan (HMO) will not be renewing its Medicare contract effective January 1, 2012. You may choose to enroll in our plan, but your coverage will automatically end on December 31, 2011 in Atlantic, Burlington, Camden, Cumberland, Gloucester, and Salem counties in New Jersey. Because this plan ends on December 31, 2011, if you decide to join, you are entitled to enroll in a new MA plan or PDP beginning December 8, 2011 through February 29, 2012. However, if you want your enrollment in the new plan to take effect on January 1, 2012, the new plan must receive your application by December 31st. You may also have the option of enrolling in a Medicare Cost Plan, if one is offered in your area. If you do not enroll in another MA plan, Medicare Cost Plan or PDP plan by December 31, 2011, you will be disenrolled from our plan and enrolled in Original Medicare on this date. You will receive additional information in the fall about your rights and additional options.
Source: aetnamedicare.com

Application to copy or transfer from one Medicare card to another form (3170)

Complete this form to copy or transfer someone on to your own Medicare card or another Medicare card. Where the transfer or copy is to another person’s Medicare card that cardholder must also sign the form.
Source: gov.au

Medicare Supplemental, Advantage, and Part D Plans

Posted by:  :  Category: Medicare

Because of the significant out-of-pocket payments required by traditional Medicare, a booming market of private-sector insurance products has grown up around the government programs. These Medicare-related insurance products are one of the fastest-growing segments of the U.S. health insurance industry, and they are the part of the market on which a smart consumer should focus his or her attention. Medicare Providers is here to help seniors, and other Medicare eligible individuals, understand these products and provide tools to assist in the decision making process.
Source: medicare-providers.net

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Advantage Health Plans: Options and Coverage

Medicare Advantage plans are private insurance health plans, regulated by the government. Medicare Advantage is also known as “MA” or Medicare Part C. All individuals enrolled in Original Medicare, Part A and Part B, are eligible to enroll in a Medicare Advantage plan, with the exception of those diagnosed with End Stage Renal Disease (ESRD), there are exceptions.
Source: planprescriber.com

Things to know about Medicare Advantage Plans

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.
Source: medicare.gov

Extra Help with Medicare Prescription Drug Plan Costs

Posted by:  :  Category: Medicare

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

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

Whistleblower lawsuit: Monroeville nurse to get $15 million for exposing Medicare false claims

- A whistle-blower lawsuit is pending in U.S. District Court in Mobile against Infirmary Health Inc. and Infirmary Medical Clinics, a corporate entity that the nonprofit set up in the 1980s to acquire physician practices. A federal magistrate judge recently recommended that the case be dismissed. The complaint describes a complicated financial relationship between the doctors and Infirmary Health. It lists $521.6 million payments from government health insurance programs from 2004 through 2010 to affiliated doctors. The suit also alleges that doctors’ pay was tied to referrals and that they received more than $18.6 million in bonuses during the time period.
Source: al.com

Another whistleblower suit alleges Medicare Advantage fraud

Whether her claims hold up in court or not, Silingo’s lawsuit is likely to draw further attention to government oversight of Medicare Advantage plans. The health plans, an alternative to standard Medicare, are mostly run by private insurance companies. They serve more than 15 million Americans, or about one in three elderly and disabled people on Medicare, at a cost to taxpayers that could reach $160 billion this year. The plans are paid based on a “risk score,” which estimates how sick patients are.  Medicare pays higher rates for sicker patients.
Source: publicintegrity.org