Health Insurance Claim Forms

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The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form required by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services. It was developed by the independent National Uniform Claim Committee (NUCC) and used by all non-institutional medical provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid State Agencies (contact your Medicaid State Agency for more details).
Source: gpo.gov

Medicare Claim form (MS014)

This information was printed Wednesday 30 March 2016 from humanservices.gov.au/customer/forms/ms014 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.
Source: gov.au

What’s Medicare Supplement Insurance (Medigap)?

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Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Find a Medigap Policy in Your Area

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Source: medicare.gov

Medigap (Medicare Supplement Health Insurance)

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992. Insurance companies can only sell you a “standardized” Medigap policy. Medigap policies must follow Federal and state laws. These laws protect you. The front of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.” It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost. You and your spouse must buy separate Medigap policies.Your Medigap policy won’t cover any health care costs for your spouse. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. You are guaranteed the right to buy a Medigap policy under certain circumstances. For more information on Medigap policies, you may call 1-800-633-4227 and ask for a free copy of the publication “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” You may also call your State Health Insurance Assistance Program (SHIP) and your State Insurance Department. Phone numbers for these Departments and Programs in each State can be found in that publication.
Source: cms.gov

Medicare: What Are Medigap Plans?

If you are going to buy a Medigap plan, the open enrollment period is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B — or within six months of signing up for Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays. If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage. If you do get covered, your rates might be higher.
Source: webmd.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

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

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

Tennessee Medicare Assistance

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Both programs work hand in hand to assist all Tennesseans with their questions and concerns about Medicare issues. Working through federally funded grants from Centers for Medicare and Medicaid Services and Administration on Aging, SHIP and SMP is administered throughout the nine Area Agencies on Aging and Disability.
Source: tnmedicarehelp.com

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

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Source: medicare.gov

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

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

Electronic Billing & EDI Transactions

The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

Competitive Bidding Program

Posted by:  :  Category: Medicare

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it pays for those equipment and supplies under the Competitive Bidding Program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers.
Source: medicare.gov

DMEPOS Competitive Bidding

Under the program, a competition among suppliers who operate in a particular competitive bidding area is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
Source: cms.gov

Competitive Bidding Program areas

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Source: medicare.gov

Contract Supplier Locations

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Source: cms.gov

Competitive bidding can help solve Medicare's fiscal crisis

1. Robert H. Miller and Harold S. Luft, “HMO Plan Performance Update: An Analysis of the Literature, 1997–2001,” Health Affairs 21, no. 4 (July/August 2002): 63–86. 2. US House of Representatives Committee on the Budget, “Wyden and Ryan Advance Bipartisan Plan to Strengthen Medicare and Expand Health Care Choices for All,” news release, December 15, 2011, www.budget.house.gov/bipartisanhealthoptions (accessed February 13, 2012). 3. Bipartisan Policy Center, Domenici-Rivlin Protect Medicare Act, December 16, 2011, www.bipartisanpolicy.org/sites/default/files/Domenici-Rivlin%20Protect%20Medicare%20Act.pdf (accessed February 9, 2012). 4. Robert Coulam, Roger Feldman, and Bryan Dowd, Bring Market Prices to Medicare: Essential Reform at a Time of Fiscal Crisis (Washington, DC: AEI Press, 2009). 5. Coulam, Feldman, and Dowd, Bring Market Prices to Medicare; Marsha Gold et al., “Medicare Advantage 2012 Spotlight: Plan Availability and Premiums,” Kaiser Family Foundation Data Spotlight (November 2011), www.kff.org/medicare/upload/8258.pdf (accessed February 9, 2012). 6. Patient Protection and Affordable Care Act, Public Law 111-148, 124 Stat. 119, 111th Cong. (March 23, 2010), amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, 111th Cong. (March 30, 2010). 7. The PPACA savings of 4.2 percent and the 5.6 percent additional savings from bidding are multiplied to get the total savings of 9.5 percent from bidding. 8. Ideally, we would like to estimate the savings from competitive bidding using actual PPACA spending as the baseline; however, data on MA plans’ bids are available only for 2009, before the PPACA was passed. This means we had to start by estimating the PPACA baseline. 9. Scott Harrison et al., “MIPPA MA Payment Report” March 12, 2009, www.medpac.gov/transcripts/MA%20pay%20rpt%203%2009%20final.pdf (accessed February 9, 2012). 10. Total benefit payments from the hospital insurance and supplementary medical insurance trust funds in 2009 were $239.3 billion and $202.6 billion, respectively, for a total of $442 billion, according to tables III.B4 and III.C8 in The 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds, May 13, 2011, www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf (accessed February 13, 2012). Our estimate of baseline Medicare spending is lower because we excluded certain expenses noted in our appendix. 11. Ibid. This projection is based on the trustees’ intermediate estimates of Medicare spending from 2011 through 2020.
Source: aei.org

Rules for Medicare health plans

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Source: medicare.gov

Medicare Marketing Guidelines

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Source: cms.gov

How Medicare Advantage Plans work

Posted by:  :  Category: Medicare

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

Medicare Advantage: Private Health Insurance Through Medicare

Medicare Advantage plans may give you some discounts or pay for services that Original Medicare may not cover. However, Medicare Advantage plans are administered by private health insurers and you’ll be required to follow your plan’s rules. Original Medicare allows you to see just about any doctor and go to any hospital that accepts Medicare , which most providers accept. With Medicare Advantage plans, you’re typically restricted to the doctors and hospitals included in the plan’s network. You might need referrals to see a specialist.
Source: webmd.com

Medicare Part B Monthly Premium 2016

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Actually, these numbers are valid for most persons on Medicare. You will have to pay a higher premium if you filed an individual tax return last year and reported income over $85,000 or $170,000 for a joint return. Depending on the amount of your taxable income, you may have to pay between $170.50 up to the maximum Part B premium of $389.80 per person. Fortunately, income-related adjustments affect less than 5 percent of Medicare beneficiaries. If you have to pay a higher Part B premium because of your income, you should be notified by Social Security.
Source: medicareanswers.org

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

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Source: medicare.gov

More Medicare Information

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