Original Medicare (Part A and B) Eligibility and Enrollment

Posted by:  :  Category: Medicare

To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Source: cms.gov

Washington D.C. Medicaid Eligibility Attorney

Medicaid is a welfare program jointly administered by the federal government and the states. Each of the states administers the program subject to their own state agencies and Medicaid Manuals. An applicant has to satisfy two eligibility criteria: first, the applicant must be aged (over 65) or disabled, and second, the applicant must have less than $2,000 in countable recourses ($2,500 in Maryland and $4,000 in D.C.). If determined eligible for custodial long-term care, Medicaid will pay the nursing care facility the costs for custodial long-term care of the eligible individual. In addition, Medicaid will pay the facility, or a third-party provider, for the cost for ancillary services provided to the individual.
Source: edlc.com

What is Medicare? What is Medicaid?

Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.
Source: medicalnewstoday.com

Best Medicare Supplement Insurance Quotes

Posted by:  :  Category: Medicare

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

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

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplement Plans in 2016

Plan G is quickly gaining in popularity due to its great coverage and lower premiums than Plan F. In fact Plan G is almost identical to Plan F in coverage except you must pay the annual Part B deductible ($147 in 2015) yourself with Plan G. After you pay this the plan pays 100 percent just like Plan F does. Many people already on Plan G will remain there as they consider it to be one of the best Medicare supplement plans for 2016.
Source: bestmedicaresupplementplans2016.com

Medicare Supplement Leads

On the outside looking in it may look like all of these rules put in place by the Centers for Medicare & Medicaid Services back in 2008 are nothing more than red tapes meant to make our ability to earn a living servicing client needs infinitely harder. However, let’s face facts; there are situations where guildelines are required to protect our aging population. The fact that many agents are staying out of the Medicare market due to regulatory breach concerns, along with NetQuote’s strict compliance with these guidelines, makes this market a potentially lucrative one for your business.
Source: bestmedicaresupplementleads.com

Medicare Supplement Insurance

“My experience with Russell Noga and Medisupps.com has been so wonderful I have to share it! My aunt and uncle needed new insurance with their move to a new state. My uncle is hearing impaired, and my aunt struggles with English. His patience and professionalism was beyond measure! He found them the very best coverage to fit their individual needs and at the best rate possible. Russell was so thorough, extremely kind, and made the entire process painless. I can’t express how grateful we feel to have found him to work through the insurance process. Thank you, Russell! Medisupps.com ROCKS!” ~ Norma Vally a.k.a Toolbelt Diva (Discovery Home Channel)
Source: medisupps.com

Which Medicare Supplement is the best?

Coverage: Do you want more cost sharing for lower premiums or do you want a policy that covers all the deductibles, coinsurance and copays that are left for a Medicare beneficiary to pay.  A Medigap Plan F is the most comprehensive plan on the market and usually will be the most expensive plan available, but it does provide security that any catastrophic incidents would be covered.
Source: medicareinsurancefinders.com

Affordable Arizona Medicare Plans

Posted by:  :  Category: Medicare

insuranceQuotes is an independent, privately-owned company that provides thousands of consumers with an effective and free way to shop and compare insurance quotes online. We are not affiliated with healthcare.gov or other state-based exchanges; however, through trusted partnerships with thousands of insurance agents in your local area and at over a hundred of the nation’s elite insurance providers, consumers using our services can receive quotes for insurance plans that may appear on state-based and/or federal exchanges, as well as for private plans that meet federal standards to be a qualified health plan under the Affordable Care Act. We do not sell health plans ourselves, but work with these licensed entities.
Source: arizonamedicare.org

Arizona Medicare Supplement: Arizona Medigap

There are plenty of companies out there advertising supplemental insurance in Arizona, but how do you know you are picking the right one? First and foremost, you have to make sure that they have competitive prices, as well as a knowledgeable and respectable staff. Arizona Medicare Supplements provides both of those things, as we serve seniors with Arizona Medigap Coverage or Arizona Medicare Supplement policies. We strive to provide affordable rates as well as complete customer service both before and after the sale.
Source: arizonamedicaresupplements.com

Medicare Choices of Arizona

January 1 – February 14th is the Medicare Advantage disenrollment period. During this period, a person can get out of their MA plan and go back to “Original Medicare. To get out of your MA plan, you enroll into Part D plan (PDP). The code for the PDP enrollment is “SEP -MADP” (Medicare Advantage Dis-enrollment…
Source: medicarechoicesofarizona.com

Arizona medicare supplement plans, Arizona medicare advantage plans

Medicare advantage plans usually have a lower premium than a Medicare supplement plan.  Many of these types of plans are commonly referred to as HMO’s.  When visiting a physician there is normally a copay.  Many times the prescription drug coverage (part D) is included in the plan.  These plans can change from year to year.  They are county specific so if you move you may be required to change your plan. 
Source: arizonamedicaresupplementplans.com

Help with Paying Medicare Costs Only

You are invited to participate in a survey regarding your experience using the AHCCCS website. This survey will take approximately two minutes. Your responses will help us ensure that you have a high quality experience.
Source: azahcccs.gov

Original Medicare appeals

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 Appeals Process Forms

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

Coventry Medicare: Grievances & Appeals

How do I submit a Part C Organization Determination to request coverage for medical services? You, your doctor, or representative can call, fax or mail your request to us. Phone and Fax: Our contact information (phone number, address, and fax number) is available to you on the contact us page of this website and in the plan’s Evidence of Coverage (EOC). You can also call us using the number on the back of your ID card. Fax: 855-788-3994 Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 What can I do if my Part C Organization Determination request is denied? If we don’t cover or pay for your benefits or services, you, your doctor, or representative can appeal our decision. You need to submit your name, address, member number and reason for appealing. Any evidence you want us to review, such as medical records, doctor’s letter or other information that explains why you need the item or services, can be submitted. Call your doctor if you need this information . For a standard appeal, mail or fax deliver your appeal to: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax: 855-788-3994 For an expedited appeal: Phone: 866-613-4977 Fax: 855-788-3994 How do I submit a Coverage Determination for my prescription drug? If you’re a member, you can request an exception if a drug has a prior authorization, quantity limit or step therapy. Not an Aetna member yet? You can call 1-877-988-3589 (TTY: 711) to get answers to your questions. You, your doctor, or representative can submit the online form, or download the form for your type of plan, and fax or mail deliver your request to us. You may also call us. Submit online form If we don’t currently cover your medication or you need prior authorization before we cover your medication, you can ask for this coverage by completing one of the forms below: First Health Part D Prescription Drug Plans Medicare Advantage Plans Fax: 1-800-639-9158 Mail: Part D – Medicare Appeals & Grievances P.O. Box 7773 London, KY 40742 Phone: Our phone numbers (standard and expedited) are on the contact us page of this website, in the plan’s Evidence of Coverage (EOC), and on your ID card. What can I do if my Coverage Determination is denied? If we deny your Prescription Drug request, you can appeal our decision. You, your doctor, or representative can submit the online form, or download the form below and mail or fax deliver it to us. Submit online form Download: Request for Redetermination of Medicare Prescription Drug Denial Fax: 1-800-535-4047 Mail: Part D Medicare Appeals & Grievances – Redeterminations P.O. Box 7773 London, KY 40742 If your request needs to be “Expedited” you can call or fax us. Expedited Phone Line: 1-800-536-6167 Expedited Fax Number: 1-800-535-4047 What can I do if I have a complaint (also called a “grievance”)? If you have a complaint about your medical or pharmacy coverage, you, your representative , or your doctor can call, fax, or write to us. For Part C Appeal and Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax #: 855-788-3994 For Part D Appeal & Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Fax #: 1-800-535-4047 Mail: Part D Appeal & Grievance P.O. Box 7773 London, KY 40742 You can contact the Office of the Medicare Ombudsman for help with a complaint, grievance, or information request. To learn more, visit https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html. How long does it take to get a decision? You can request either a “Standard” or “Expedited” (fast) decision process. If your health requires it, you can ask us to give you a "fast coverage decision". A "fast coverage decision" is called an "expedited coverage determination" or an “expedited organization determination”. When we give you our decision, we will use the "standard" deadlines unless we have agreed to use the "fast" deadlines. We will respond to your request no later than the below timeframes. Request for an Coventry Medicare Advantage Plan (Part C) Organization Determination  Standard Process = Pre-service: 14 days     Claims: 60 days Expedited Process = Pre-service: 72 hours     Claims: n/a Request for a Coventry Medicare Advantage Plan (Part C) Organization Determination Denial Standard Process = Pre-service: 30 days Claims: 60 days Expedited Process = Pre-service: 72 hours Claims: n/a Request for Prescription Drug Coverage Determination Standard Process= 72 hours Expedited Process= 24 hours Request for Redetermination for a Coventry Medicare Prescription Drug Denial Standard Process= 7 days Expedited Process= 72 hours Coventry Medicare Advantage Plan Grievance Standard Process= 30 days Expedited Process= 24 hours Prescription Drug Plan Grievance Standard Process= 30 days Expedited Process= 24 hours
Source: coventryhealthcare.com

Medicare Part C Appeals > Home

ATTENTION MEDICARE HEALTH PLANS: Updated Medicare Advantage Process Manual, PACE Process Manual, Appendix, Reconsideration Background Data Form, and Dismissal Case File Data Form are now available under the ‘Health Plans’ section.
Source: medicareappeals.com

Medicare Leads for T65, Med Supps and Insurance Sales

Posted by:  :  Category: Medicare

We are committed to provide quality leads to Insurance agents. Our partnership enables the insurance agents to have high volume leads that provide them the prospective buyers who are actively searching in the market for health insurance plans. As the providers of the best quality leads we are committed to satisfy the insurance agents as well as the consumers. All the insurance agents who buy our leads experience more Medicare Advantage enrollments and Medicare supplements since they are able to get easily the prospective customers who are really interested to buy the particular insurance plans. As a result the consumers are able to get an immediate quote online from the agent. For the consumers, it will be a smooth, easy and quick process. By providing an easy, comfortable and reliable service we make the consumers to buy the insurance plans from the agent. Hence, the agents who buy the leads from us are assured of a higher close ratio. We provide them exclusive health insurance leads that enable them to expand their customer base rapidly.
Source: medicareleadsandpresetappointments.com

Medicare Supplement & Advantage Leads

Looking to grow your business during the Annual Enrollment Period? Precise Leads is the number one provider for the top Medicare carriers during the AEP. Our quality and lead volume can result in a huge lift in your revenue during this special time of year. Whether you sell Medicare Supplement, Medicare Advantage or both, the increased volume during the AEP will be reflected in your sales reports.
Source: preciseleads.com

Medicare Supplement Leads and Medicare Advantage Leads

Over 65 Medicare Supplement leads cannot be overlooked. There are so many Americans paying more than they need to. They understand the process. They are NOT bombarded with mail. If you sell one of the top two lowest carriers in your market, this is a remarkable marketing tool.
Source: targetleads.com

Free Medicare Supplement & Advantage Leads for Insurance Agents

As an aside, the guaranteed policy works very well with spouses of Medicare eligible for obvious reason. In many states it is virtually impossible for a 60 year old to acquire private insurance from the traditional health insurance company. The 60 year old is often times a spouse of a Medicare recipient. The entire guaranteed health sale process is on a user-friendly web site. We’ll give you the web site. We have partnered with the insurer that is the industry leader. Sales to groups are encouraged as well. Getting a Medicare policy is a hassle-free task. You can obtain quotes from top-notch insurance providers within seconds.
Source: bestmedicaresupplement.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

On the outside looking in it may look like all of these rules put in place by the Centers for Medicare & Medicaid Services back in 2008 are nothing more than red tapes meant to make our ability to earn a living servicing client needs infinitely harder. However, let’s face facts; there are situations where guildelines are required to protect our aging population. The fact that many agents are staying out of the Medicare market due to regulatory breach concerns, along with NetQuote’s strict compliance with these guidelines, makes this market a potentially lucrative one for your business.
Source: bestmedicaresupplementleads.com

Life Insurance Leads, Final Expense Leads Sales Associate

Our marketing approach can play a huge role in increasing your sales. By using our services will keep you and your team of sales agents doing exactly what you should be doing…selling! We have the experience and the expertise with years of service. Our cost effective method of life insurance leads, Medicare supplement leads, reverse mortgage leads generation will place you in front of your desired prospect. We will qualify them and set an appointment based off your desired schedule. Sales Associate® specializes in lead generation for Medicare supplement, Reverse Mortgage, Home Health Care and Final Expense Leads. No more cold-calling and spending hours and hours on the phone finding prospects. Our highly skilled appointment setters can schedule appointments for you to meet with the prospects within the time frame you would want to schedule your meetings. You don’t have to call them just show up for the appointment. Many other telemarketing companies will not offer our level of service without hiking up the expense to the client. With all the great benefits of our services, we still manage to maintain a very competitive pricing compared to other telemarketing companies. We do all the leg work and charge a fraction of the cost for a qualified appointment. Telemarketing is an important function for all your marketing needs and it plays a huge role in expanding the business and ensuring good publicity and targeting your potential client. For over 10 years Sales Associate® has been consistently providing top senior marketers with excellent life insurance leads, Medicare supplement leads, reverse mortgage telemarketing leads and real estate leads in the form of solid appointments and phone leads. Our motto is in creating an atmosphere with the customer using the combined experience to maintain an excellent relationship with the customer. Official Company Web page
Source: us-leads.com

Highmark Direct :: Medicare Information

Posted by:  :  Category: Medicare

Highmark is a registered mark of Highmark Inc. Highmark Choice Company, Highmark Senior Health Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal. Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company are independent licensees of the Blue Cross and Blue Shield Association.
Source: highmarkdirect.com

Highmark Medicare Services is now Novitas Solutions

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Highmark: Your Health Care Partner

Highmark Inc. is a national, diversified health care partner serving members through its businesses in health insurance, dental insurance, vision care and reinsurance. Our mission is to make high-quality health care readily available, easily understandable and truly affordable in the communities we serve.
Source: highmark.com

Coventry Medicare: Advantra (HMO

Posted by:  :  Category: Medicare

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

Commonly Used Medicare Modifiers

+Manny Oliverez is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE
Source: capturebilling.com

Medicare Plans for Different Needs

Learn about UnitedHealthcare Medicare Advantage plans, Medicare prescription drug plans and Medicare Special Needs plans that might be a good fit for you. Or learn about Medicare-related plans, like Medicare Supplement Insurance plans*.  
Source: uhcmedicaresolutions.com

MEDICARE PECOS for Physicians, Staff, and HME

Posted by:  :  Category: Medicare

What does the acronym PECOS mean? The Provider Enrollment, Chain and Ownership System What is it? PECOS is a new way for physicians and other health care practitioners to modify their provider file online.  Physicians must enroll with the system to use it. PECOS was designed so that the referring physician’s credentials can be verified before Medicare claims are paid. What does it cost? Nothing! I’m already enrolled in Medicare, do I need to enroll with PECOS also? YES! You must enroll with PECOS before July 6, 2010. If you have enrolled with the program since 2003 you may already be in the system. HOWEVER, it is very important to your patients that you verify your PECOS status. Otherwise they may not receive the items you prescribe. Why haven’t I heard of it before? Medicare has encouraged physicians to update their provider files since 2006. However, it has never impacted the payment of claims for referred items or services. Beginning in October of 2009 the first phase of the system was implemented. Under the first phase claims are being paid but with a warning that the provider is not in the PECOS system. The second phase begins on July 6, 2010. At that time claims for items referred by physicians who are not in the system will deny. What other professional must register with PECOS? Non-physician practitioners who are eligible and those are:
Source: getpecos.com

Medicare Enrollment Application Information

Providers who are enrolled in Medicare but have not yet established a record in PECOS may be required to submit an Initial Enrollment application to establish a record in PECOS. If the reason for the application submittal is to change the information on the existing Medicare enrollment, and is not for the purpose of adding a practice location, then the Provider is not required to pay the application fee.
Source: hhs.gov

Texas Medicare Supplements

Posted by:  :  Category: Medicare

Most existing beneficiaries will be "held harmless" and will pay $104.90 in 2016. Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016. 
Source: medicare-texas.net

Texas Medicare Part D & Medicare Advantage Plans

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 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 Prescription Drug Coverage (Medicare Part D)

Medicare sets standard costs for the prescription drug benefit each year. Private companies approved by Medicare offer plans with different costs and selections of prescription drugs. You can select a plan based on the prescriptions you take and select a company that is most effective for you. To reduce your costs, enter your medications on Medicare’s secure online Find health and drug plans website. You will pay more if your prescriptions are not in the plan formulary or the plan restricts or limits their use.
Source: texas.gov

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

Posted by:  :  Category: Medicare

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

Opting Out of Medicare: a guide for physicians

I, ______, declare under penalty of perjury that the following is true and correct to the best of my knowledge, information, and belief: 1. I am a physician licensed to practice medicine in the state of ______. My address is at _________, my telephone number is _________, and my [national provider identifier (NPI) or billing number, if one has been assigned, uniform provider identification number (UPIN) if one has been assigned, or, if neither an NPI nor a UPIN has been assigned, my tax identification number (TIN)] is _________. I promise that, for a period of two years beginning on the date that this affidavit is signed (the “Opt-Out Period”) and continuing indefinitely with automatic extensions of the 2-year opt out period unless terminated by me as allowed by Title 1 Section 106(a)(1) Medicare Access and CHIP Reauthorization Act of 2015, I will be bound by the terms of both this affidavit and the private contracts that I enter into pursuant to this affidavit. [NOTE: Your personal UPIN number must be used, not a corporate UPIN number. Persons opt out, not corporations.] 2. I have entered or intend to enter into a private contract with a patient who is a beneficiary of Medicare (“Medicare Beneficiary”) pursuant to Section 4507 of the Balanced Budget Act of 1997 for the provision of medical services covered by Medicare Part B. Regardless of any payment arrangements I may make, this affidavit applies to all Medicare-covered items and services that I furnish to Medicare Beneficiaries during the Opt-Out period, except for emergency or urgent care services furnished to Beneficiaries with whom I had not previously privately contracted. I will not ask a Medicare Beneficiary who has not entered into a private contract and who requires emergency or urgent care services to enter into a private contract with respect to receiving such services, and I will comply with 42 C.F.R. § 405.440 for such services. 3. I hereby confirm that I will not submit, nor permit any entity acting on my behalf to submit, a claim to Medicare for any Medicare Part B item or service provided to any Medicare Beneficiary during the Opt-Out Period, except for items or services provided in an emergency or urgent care situation for which I am required to submit a claim under Medicare on behalf of a Medicare Beneficiary, and I will provide Medicare-covered services to Medicare Beneficiaries only through private contracts that satisfy 42 C.F.R. § 405.415 for such services. 4. I hereby confirm that I will not receive any direct or indirect Medicare payment for Medicare Part B items or services that I furnish to Medicare Beneficiaries with whom I have privately contracted, whether as an individual, an employee of an organization, a partner in a partnership, under a reassignment of benefits, or as payment for a service furnished to a Medicare Beneficiary under a Medicare+Choice plan, during the Opt-Out Period, except for items or services provided in an emergency or urgent care situation. I acknowledge that, during the Opt-Out Period, my services are not covered under Medicare Part B and that no Medicare Part B payment may be made to any entity for my services, directly or on a capitated basis, except for items or services provided in an emergency or urgent care situation. 5. A copy of this affidavit is being filed with [the name of each local Medicare carrier], the designated agent of the Secretary of the Department of Health and Human Services, no later than 10 days after the first contract to which this affidavit applies is entered into. [FOR PARTICIPATING PHYSICIANS ONLY: My Medicare Part B Participation agreement terminates on the effective date of this affidavit.] Executed on [date] by [Physician name] [Physician signature]
Source: aapsonline.org

Medicare.gov Physician Compare Home Page

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

Avoid Medicare Fraud Claims by Coding Correctly

You may believe you are beyond reproach if you don’t order a mobile scooter for every patient or dump your patient records in the nearest landfill, but you should exercise caution in these cautionary times: what the feds consider “fraud” is much broader than your definition. E&M coding, for instance is a potential target; the 99213 and 99214 office follow-up codes were the top two CPT codes in terms of both charges and unit volume in 2010. Don’t let your practice be caught up in Medicare’s recovery program. It’s a simple matter to examine your own coding patterns and compare them to national utilization data collected by Medicare. Knowing how you compare to others within your specialty is important in assessing possible exposure to recovery efforts.
Source: physicianspractice.com

Primary care physicians now accepting new Medicare plans :: News of the Week

As a result, the primary care group is working together to enhance access to patients’ personal physicians and make Loma Linda University Health’s offices, phones, website and other services easy to use as the organization moves forward with a new focus to enhance patient satisfaction and accessibility.
Source: llu.edu