Help fight Medicare fraud

Posted by:  :  Category: Medicare

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Source: medicare.gov

Report Medicare Fraud and Medicaid Fraud and get a whistleblower reward

The largest area of fraud against the government today is against Medicare fraud and Medicaid fraud. Approximately 10% of all Medicare/Medicaid bills are inflated or fraudulent. That helps explain why the Department of Justice pays such large whistleblower rewards for reporting Medicare fraud.
Source: howtoreportfraud.com

Medicare Fraud Reporting Center

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

How to Report Fraud and Suspected Fraud

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Source: cms.gov

Welcome to Your Texas Benefits

Posted by:  :  Category: Medicare

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

TEXAS MEDICAID APPLICATION

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

Health and Human Services Commission

The Centers for Medicare and Medicaid Services (CMS) recently announced that the previous March 24, 2016 deadline for Medicaid provider re-enrollment is extended to Sept. 24, 2016. Though this extension gives states additional time to ensure providers comply with Patient Protection and Affordable Care Act (PPACA) requirements, Texas Medicaid encourages all providers who have not yet submitted a re-enrollment application to begin this process immediately to avoid potential payment disruptions. 
Source: tx.us

Asset Protection Specialists Massachusetts

Posted by:  :  Category: Medicare

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

Massachusetts Medicaid: MassHealth Eligibility, Income Guidelines, Help

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
Source: quickbrochures.net

MassHealth: Medicaid in Massachusetts

Other than these four exceptions in 42 USC 1396p(d)(2)(C), all Massachusetts trust law applies to an Irrevocable Trust in a MassHealth application.  The United States Court of Appeals for the Third Circuit has already examined Congressional intent in this context, and concluded:  “Congress rigorously dictates what assets shall count and what assets shall not count toward Medicaid eligibility.  State law obviously plays a role in determining ownership, property rights, and similar matters.” Lewis v. Alexander, 685 F.3d 325, 334 (3d Cir. 2012) “[T]here is no reason to believe [Congress] abrogated States’ general laws of trusts.  … After all, Congress did not pass a federal body of trust law, estate law, or property law when enacting Medicaid.  It relied and continues to rely on state laws governing such issues.” Lewis at 343.
Source: masshealth.info

Massachusetts MassHealth (Medicaid)

Massachusetts Medicaid (MassHealth) pays for health care for certain low and medium income people living in Massachusetts. MassHealth offers health-care benefits directly or by paying part or all of your health-insurance premiums. MassHealth offers different types of coverage based on your age, whether you are a parent, pregnant, disabled HIV positive or have breast or cervical cancer, and whether you work for a small employer. MassHealth will decide if you are eligible and give you the most complete coverage that you qualify for.
Source: benefits.gov

Searchable Drug List for Massachusetts Medicaid

The MassHealth Drug List online database indexes drugs covered by MassHealth. It also details any prior authorization requirements or quantity limits. Before our consulting team launched the new database, the Massachusetts Executive Office of Health and Human Services website featured a simple alphabetical catalog of brand name and generic prescription drugs, accompanied by therapeutic class tables.
Source: umassmed.edu

2016 Medicaid Nursing Home Care Numbers for Massachusetts

You can download and read the 2016 Medicaid Nursing Home Care Coverage Figures which include definitions of the Community Spouse Asset Allowance, the Minimum Monthly Maintenance Needs Allowance (Minimum MMNA), and the principal residence equity allowance. These regulations help to protect the spouse living at home. State and federal laws come into play, along with thousands of Medicaid regulations: regulations that determine whether you are financially eligible regulations that say who can be an authorized representative who signs a MassHealth application regulations on who can file an appeal if your application gets denied. In addition to the regulations, MaasHealth has Eligibility Operations Memos that talk about whether you must privately pay for nursing home care from your own funds.
Source: masshealthhelp.com

Medicare Advantage Rates & Statistics

Posted by:  :  Category: Medicare

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Source: cms.gov

FICA & Medicare Withholding Rates

IRS Section 125 plans, such as a medical and dental that meets the agency’s Section 125 criteria, are not subject to FICA and Medicare taxes. If an employee has such a plan, the employer subtracts the nontaxable benefit from the employee’s gross pay before subtracting FICA and Medicare taxes. The amount after subtracting the benefit is also called the employee’s taxable wages. The employer includes the employee’s FICA and Medicare tax withholding for the year on her W-2 form. The employer files the form with the Social Security Administration and gives the employee a copy to file her tax return with the IRS.
Source: chron.com

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

National Provider Identifier Standard (NPI)

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

What Is Medigap vs Medicare Advantage?

Posted by:  :  Category: Medicare

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

How to compare Medigap policies

Posted by:  :  Category: Medicare

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Source: medicare.gov

Medicare Supplement Plan F

* 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

Find The Best Rate For Medicare Plan F With MediGap Advisors

Disclaimer: Medigap Advisors is not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on this website. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.
Source: medigapadvisors.com

North Coast Medical Supply

Posted by:  :  Category: Medicare

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

Diabetes supplies & services

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
Source: medicare.gov

Medicare: American Diabetes Association®

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

Medicare Coverage FAQs for OneTouch® Diabetes Supplies

The Centers for Medicare and Medicaid Services (CMS) implemented the national mail order competitive bidding program on July 1, 2013. The program reduced reimbursement rates for diabetes testing supplies and the number of mail order companies approved to provide these supplies to Medicare patients. All retailers have the ability to provide supplies to Medicare patients.
Source: onetouch.com

Medicare Coverage for Diabetes Supplies

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

Medicare & Secondary Insurance

Posted by:  :  Category: Medicare

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

Medicare as a Secondary Insurance Customer

Often policies have a tendency to overlap or duplicate each other. Take young person’s Medicare health care plans for instance:  often these can reduce the amount paid out by a percentage via a ‘reduction in benefits’ clause, particularly if they are protected under their parent or guardian’s plan. Should this be the case, a secondary insurance policy will pay the balance that is not paid by the primary insurance policy.
Source: bestmedicaresupplement.com

Medicare can be primary or secondary to employer insurance

It is very important that you talk to your benefits manager at your job when you become eligible for Medicare, as your employer insurance will work differently with Medicare. Sometimes companies do not realize that you are eligible for Medicare and they may continue to pay primary when they should not be. When the company realizes they may be able to take back money they paid for your medical services while you should have had Medicare and you may be left very large bills.
Source: medicareinteractive.org

Will my secondary insurance pay for my Medicare deductible and/or 20 percent coinsurance?

Beneficiaries enrolled in Original Medicare may choose to enroll in a Medicare Supplement plan to fill in the gaps in coverage and cover some of the costs of care not covered through Original Medicare. Some Medicare Supplement plans cover the out-of-pocket costs associated with Original Medicare, such as deductibles and coinsurance payments. Therefore, some Medicare Supplement plans may pay for your deductible and/or your coinsurance and/or other out-of-pocket costs not covered by Original Medicare. Contact your Medigap plan directly to see if it covers these costs.
Source: ehealthmedicare.com

How Does Secondary Health Insurance Work?

A standalone accidental policy is generally a secondary health insurance policy. This type of supplemental insurance pays if the policyholder is involved in an accident. The policy may have limitations based on what coverage the primary policy provides or may pay specific amounts for specific services. For example, suppose a visit to the emergency room costs the policyholder $10,000 in total charges. The primary health insurance plan then agrees to pay $8,000 of the cost. The accidental policy, the secondary insurance in this example, would then be billed for the remainder.
Source: ehow.com

Medicare Secondary Payer Act Blog

Under well-established Florida common law, the admission of evidence of social legislation benefits such as Medicare, Medicaid, or Social Security is considered highly prejudicial. However the decision in Stanley constituted a notable, narrow exception to the common law evidentiary rule precluding the admission of social benefits. In Stanley the plaintiffs alleged that the defendants’ medical negligence resulted in intellectual disability and cerebral palsy for their son. After the plaintiffs presented evidence of future damages, the court permitted the defendants to introduce evidence of “free or low-cost charitable and governmental programs available in the community to meet” the needs of plaintiffs son. The court reasoned that keeping evidence of benefits available to all citizens should be admissible for the jury in determining reasonable future care cost, to avoid an unnecessary and undeserved windfall to the plaintiff. After the decision in Stanley, in an effort to reduce insurance costs and prevent plaintiffs from receiving windfall recoveries, that Florida legislature promulgated Florida statute § 768.76, which requires trial courts to reduce damage awards by the amount of benefits paid or otherwise available to claimants, from all collateral sources. §768.76 (1). There are no reductions, however, “for collateral sources for which a subrogation or reimbursement right exists.” Id.  The statute also expressly states that benefits received under Medicare or similar federal programs which provide for a lien on or a right to reimbursement from plaintiff’s recovery are not considered collateral sources. § 768.76(2)(b). In Joerg, the Court was specifically faced with the question of whether the exception to the collateral source rule created in Stanley applies to future benefits provided by social legislation such as Medicare. The plaintiff in Joerg was a developmentally disabled adult who due to his disabilities, was entitled to reimbursement from Medicare for his medical bills. After being struck by a car, the plaintiff filed suit against State Farm Automobile Insurance Company (“State Farm”). The trial court precluded State Farm from introducing evidence of plaintiff’s future Medicare or Medicaid benefits, and judgment was entered on behalf of the plaintiff. On appeal, the Second District noted that the promulgation of the Florida statute left the viability of Stanley in question, but ultimately held that the plaintiff’s benefits were free and unearned, and therefore admissible under Stanley.
Source: themedicarespa.com

How Medicare works with other insurance

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

When Is Medicare Secondary?

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

Medicare Secondary Payer (MSP)

If you are unable to locate a specific item or topic, we will be happy to provide assistance navigating our website. Fill out this short form and we will make every effort to reply within 24 to 48 hours!
Source: cahabagba.com

National health insurance

Posted by:  :  Category: Medicare

National schemes have the advantage that the pool or pools tend to be very very large and reflective of the national population. Health care costs, which tend to be high at certain stages in life such as during pregnancy and childbirth and especially in the last few years of life can be paid into the pool over a lifetime and be higher when earnings capacity is greatest to meet costs incurred at times when earnings capacity is low or non existent. This differs from the private insurance schemes that operate in some countries which tend to price insurance year on year according to health risks such as age, family history, previous illnesses, and height/weight ratios. Thus some people tend to have to pay more for their health insurance when they are sick and/or are least able to afford it. These factors are not taken into consideration in NHI schemes. In private schemes in competitive insurance markets, these activities by insurance companies tend to act against the basic principles of insurance which is group solidarity.
Source: wikipedia.org

National Health Insurance Company

We work hard to ensure doing business with us is as easy as possible by creating broad brackets that are simple to customize and by providing high touch customer service via our readily accessible state-of-the-art call center. Whether you’re working with individuals, groups or associations, you’ll be able to provide products that fit their budgets and meet their specific needs.
Source: nhic.com

National Health Insurance (Japan)

When a NHI member gives birth, ¥420,000 will be provided for each child. This allowance is also paid in cases of miscarriage or stillbirth if this occurs after 85 days (4 months) of pregnancy. However, this will not be provided to those who receive a childbirth allowance from other health insurance programs. The mother presents her NHI card at the hospital, and NHI will pay the hospital directly. If the cost of childbirth is more than ¥420,000 the member must pay the remainder. If the cost is less than ¥420,000, the member will receive the balance. A form will be sent approximately 2 months after delivery, which must be returned to claim the balance.
Source: wikipedia.org

What is national health insurance? definition and meaning

A system of insurance benefits established by a federal government to cover all or almost all of the citizens of the country. These systems are entirely or partially funded with tax money. The United States is developing a program like this.
Source: businessdictionary.com

Before Obamacare, the National Health Insurance Plan

According to its supporters, Health Care for America will provide comprehensive coverage. Along with all current Medicare benefits, the plan will cover mental health and maternal and child health. Unlike Medicare, Health Care for America will place limits on total annual out-of-pocket costs paid by enrollees. Drug coverage would be provided directly by Health Care for America, rather than by private health plans. Medicare would be modified to allow it to provide the elderly and disabled with the same direct drug coverage. In addition, preventive and well-child checkups would be provided to all beneficiaries at no out-of-pocket cost.
Source: about.com