Medicare Summary Notice (MSN)

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MSNs are usually mailed four times a year and contain information about submitted charges, the amount that Medicare paid, and the amount you are responsible for. Note that you may receive an MSN more often if you are being reimbursed for a bill you paid. You can also access your MSN online at www.mymedicare.gov. This site allows you to look at electronic versions of your MSNs and print copies from your own computer whenever you would like (but it does not replace the paper MSN).
Source: medicareinteractive.org

Get your Medicare Summary Notices (MSNs) electronically

Did you know you can now get your MSNs electronically? You can view and print your MSNs online at MyMedicare.gov by signing up for electronic MSNs (eMSNs). With eMSNs, you won’t have to wait 3 months to get your paper MSNs. You’ll get an email each month letting you know that your eMSNs are ready to view and print.
Source: medicare.gov

How to Read Your Part B Medicare Statement

Medical procedures and services are assigned billing codes. You have the right to receive an itemized billing statement that lists each medical service you received. If you need an itemized statement, contact your doctor. Compare the billing code on your MSN with the code that appears on the billing statement you received from your doctor. If the codes are different, or if you didn’t receive the medical service indicated, contact the doctor who is making the claim. It may be a simple mistake that the doctor’s office can easily correct. If the office does not resolve your concerns, call Medicare at 1-800-MEDICARE (1-800-633-4227).
Source: aarp.org

Medicare Part D coverage gap

Posted by:  :  Category: Medicare

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically *not* counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

Get Medicare Part D Quotes in Seconds

As could be expected, prices for Humana policies rocketed for the 2015 calendar year. Mean premiums for Humana Part D jumped from $21.80 to $38.70. Medicare Part D is priced at $41.55 and Part D Medicare comes in at the slightly lower price of $38.80. Humana’s standalone market share coverage has dropped to 18.6% whereas their Medicare Part D policies have increased to a market share of 12.8%.
Source: medicareaide.com

Medicare Plans & Coverage: Part A, Part B, Part C, Part D

To be eligible for Medicare, one must be a permanent resident or an American citizen 65 years or older, or younger with a qualifying disability. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Source: medicareconsumerguide.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 Part D Drug Benefit

Tiered-cost sharing All Part D plans use tiered cost sharing. Drugs in each tier have a different cost. A drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, a flat copayment may be replaced with coinsurance (a percentage of the drug’s cost). If your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug in a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
Source: alz.org

Insurance claim denial and appeal: Denial reason

Posted by:  :  Category: Medicare

Medicare Presumptive Payment Adjustments & Denials Medicare presumptive payments are based upon the Social Security issuing a presumptive SSI that someone will actually start benefits before they have officially qualified. There are many severe conditions that will help a person to qualify for presumptive Medicare allow them to start paying into this category to get benefits to kick in. The standard method could take six months for all of the paperwork to be completed and the claim to be reviewed. This way, a person can begin Medicare benefits and healthcare immediately. When a patient is under presumptive Medicare, they will visit the doctor as they would with any other type of insurance. The doctor’s billing company then needs to use the proper code for Presumptive payment. If the Presumptive payment code is used for anything other than for this reason, there may be a denial, often as an A7 denial code: Presumptive payment adjustment. The reason that many medical providers are getting the A7 denial code, however, is because they are using it to force balance the transactions. FIs, or Fiscal Intermediaries, are reporting the add-on payment in the claim/service adjustment segment as an additional payment that has already been included in the allowed amount. This is what’s causing the out-of balance on the books, which is why many are using A7 to offset the difference. The Medicare Presumptive payment adjustment doesn’t typically affect the patients in a negative way. In fact, it will help most of them when used properly because they will get the care that they need in a timely manner as opposed to waiting for paperwork to process. They will be able to pay only what is required (if anything) so that they can get treatment.
Source: insuranceclaimdenialappeal.com

Medical Billing and Coding Guidelines and tips to improve billing.: Medicare denial code CO 50 , CO 97 & B15

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

Private Health Insurance, Individual, Group, Family Healthcare

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Bupa Travel Insurance is sold by Bupa Insurance Services Limited and underwritten by AIG Europe Limited. Bupa Insurance Services Limited is authorised and regulated by the Financial Conduct Authority (FCA number 312526). AIG Europe Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority (FCA number 202628) and the Prudential Regulation Authority. This information can be checked by visiting the Financial Conduct Authority website (www.fca.org.uk).
Source: co.uk

Health Insurance: Private Medical Insurance

Bupa health insurance and cash plan are provided by Bupa Insurance Limited. Registered in England and Wales No. 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales No. 3829851. Registered office: Bupa House, 15-19 Bloomsbury Way, London WC1A 2BA.
Source: co.uk

International Health Insurance & Medical Insurance

Over 40 years of medical expertise and dedication to health. A global team of advisers and health experts who, between them, speak multiple languages – and a service that exceeds expectations. These are just a few of the things that make Bupa Global different. Explore how we provide you with world-class cover and stand apart from the rest.
Source: bupaglobal.com

Hospice care coverage in Part A

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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

Understanding the Hospice Medicare Benefit

It doesn’t cover the cost of room and board. This isn’t usually a problem if you’re in your own home. But, if you are in a nursing home, assisted living facility, board and care home, or living at a hospice facility, you’ll be responsible for covering your board and care costs. If it’s clear that you need to live in a nursing home, assisted living, or hospice house but can’t afford room and board, some hospice organizations will use charitable donations to assist you with those costs. This is usually done on a case-by-case basis, so if you predict this may be an issue, ask about it as you’re choosing which hospice organization to use.
Source: about.com

Does Medicare pay for hospice services?

Room and board Medicare doesn’t cover room and board for hospice care. It does not cover the cost of rent or fees for a home, nursing home or assisted living. However, if the hospice medical team determines that your loved one needs short-term inpatient or respite care services that they arrange, then the stay in the nursing home or assisted living facility is covered. If your loved one’s permanent home was already in the nursing home, hospice care is covered. Your loved one may have to pay a small copayment for the respite stay.
Source: agingcare.com

Solution to Medicare Part B Cost Increases? Look at “Outpatient” Observation Status 

Posted by:  :  Category: Medicare

Part A is called “Hospital Insurance” in the Medicare Act. Yet, thousands of patients stay in hospitals for many days only to learn they were not admitted as inpatients. Instead, they are classified as outpatients on Observation Status. One of the myriad consequences of this policy is that Part B expenses are skyrocketing – increasing Part B premiums and deductibles and cost shifting to Medicare beneficiaries. These costs should not be included in calculating the share of Part B costs that beneficiaries must pay.
Source: medicareadvocacy.org

What is the Difference Between Medicare Part A and Medicare Part B?

At age 65, if you are eligible to receive or are receiving Social Security benefits, you may be automatically be enrolled in Medicare Part A if you paid Medicare taxes while employed. Some Part A recipients are automatically enrolled in Part B as well. However, since you must pay a premium for Medicare Part B benefits, you have an option to refuse this coverage. If you’re not automatically enrolled in Part B and wish to apply, you must first be enrolled in Part A to be eligible. You can sign up for Medicare benefits beginning three months prior to your 65th birthday. The program also conducts a general enrollment period annually during the first three months of the year.
Source: ehow.com

Medicare Part B Medical Insurance

You can get further information about coverage under Medicare Part B by calling the Social Security Administration at (800) 772-1213 or by visiting www.ssa.gov (the Social Security Administration website) or www.medicare.gov. The Medicare website contains a comprehensive list of covered services, including a preventive care checklist that you can take to your health-care provider to find out which services are right for you.
Source: medicare.org

When & how to sign up for Part A & Part B

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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

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

Enroll for Medicare Part B: Step By Step Guide

If you are automatically enrolled in Part B, you will receive your card in the mail three months before your benefits are scheduled to begin (except for those with ALS). You do not have to accept Part B. Your card comes with instructions for rejecting coverage. Simply follow them and send the card back if you do not wish to receive Part B coverage. You will pay Part B premiums as long as you keep the card.
Source: mymedicaremedicaid.com

Original Medicare (Part A and B) Eligibility and Enrollment

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

Medicare Physical Therapy Rules & Regulations

Posted by:  :  Category: Medicare

Medicare’s combined cap for physical therapy, or PT, and speech language pathology services, or SLP, is $1,940 per calendar year. You are limited by the $1,940 cap whether you do only PT, only SLP, or a combination of both. Medicare permits an exception to this cap if your physical therapist certifies that additional therapy is medically reasonable and necessary for you to improve, maintain function or not lose more function. This certification must be fully documented in your medical record and on the Medicare claim form. If Medicare approves additional therapy, it will be limited by a combined PT and SLP threshold of $3,700. Once you reach $3,700, Medicare may initiate a special review of your medical records to justify further coverage.
Source: ehow.com

Medscape: Medscape Access

Medscape uses cookies to customize the site based on the information we collect at registration. The cookies contain no personally identifiable information and have no effect once you leave the Medscape site.
Source: medscape.com

Medicare Regulations Are Driving a Wedge Between Obstructive Sleep Apnea Patients and Their Providers

With over 52 million enrolled beneficiaries, Medicare’s policies and practices influence a large percentage of America’s healthcare population (1). With some studies estimating that as many as 20 percent of the American adult population (with higher numbers in the older population) suffer from Obstructive Sleep Apnea (OSA), this means that Medicare’s policies affect many with this condition (2). As of July 1, 2013, Medicare has the strictest policies of any insurer on the administration and maintenance of continuous positive airway pressure (CPAP) devices and supplies for the treatment of OSA. On the surface, the rationale for some of these policies may seem logical. However, the unbending enforcement of these Medicare rules regarding durable medical equipment (DME) has led to unintended consequences, including the repossession of CPAP machines from patients, extended delays in administration of equipment related to OSA, denial of continuation of treatment for patients who have been using CPAP for years, and damaged relationships between patients and healthcare providers.
Source: huffingtonpost.com

EmblemHealth: Family & Individual Health Insurance Plans In New York

Posted by:  :  Category: Medicare

If you need help determining the best place to seek care, call our toll-free Nurse Advice Line at 1-877-444-7988 to speak with a registered nurse without waiting for a call back. A registered nurse can guide you to the help you need now. This service is available 24 hours a day, seven days a week.
Source: ghi.com

Urgent Care is "In Network" Aetna, HIP, GHI, Emblem, United, Oxford, Empire, 1199, Cigna, Blue Cross Blue Shield, Health Republic, Metroplus

Statcare accepts all major Insurances.  Statcare is also designated as an in-network urgent care facility of choice with most insurance plans. Our walk-in clinic accepts all insurance except Medicaid, Fidelis Medicaid, HealthPlus Medicaid.
Source: statcarewalkin.com

EmblemHealth: Resources for Doctors, Hospitals and other Providers

To view this Web site, you need to have JavaScript enabled in your browser. Don’t worry — you can still sign in to the secure myEmblemHealth Web site or search for a doctor using the links below. If you need help registering for the secure site, please call Customer Service at the number on the back of your ID card.
Source: ghi.com

EmblemHealth: Health Insurance Plans in NY

Quality health care coverage at little or no cost. EmblemHealth is happy to offer New York state-sponsored Medicaid Managed Care, Enhanced Care Plus (HARP), Child Health Plus and Managed Long Term Care health insurance plans to eligible individuals and families throughout New York City, Long Island and Westchester County.
Source: emblemhealth.com

Medicare PFFS Information for Providers

Previously, Deseret Mutual members covered by Medicare were enrolled in Deseret Secure, a Medicare Advantage Private Fee-for-Service plan. All claims were sent to Deseret Mutual and we paid the benefits for both Medicare and Deseret Mutual. Beginning January 1, 2013, Deseret Mutual members on Medicare will be enrolled in Deseret Alliance, a Medicare Supplement plan. Providers must send claims directly to Medicare. After Medicare processes the claim, the claim and Medicare’s payment information is automatically sent electronically to Deseret Mutual for processing. This is referred to as crossover billing. The electronic claims file is sent through Group Health Incorporated (GHI), the designated coordination of benefits contractor for Medicare claims.
Source: dmba.com

Contact Information and Websites of Organizations for Medicare

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Source: medicare.gov

Careers at SSA: USA Office Locations

Six program service centers serve the needs of the Social Security public nationwide. Located in New York, San Francisco, Philadelphia, Chicago, Kansas City, and Birmingham, these centers perform a variety of Social Security’s mission-critical tasks, including account maintenance, disability claims review, and benefits determinations.
Source: ssa.gov

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