Data and risk adjustment are important parts of calculating the quality measures. However, a detailed understanding of the adjustment procedures isn’t necessary for the average user of Nursing Home Compare. Scientists involved in research on the measurement of quality in nursing home care have advised CMS on the methods of risk adjustment, and CMS believes this is the best science available at this time. The following detailed information is presented for those who are interested. The quality measures on Nursing Home Compare were adjusted using exclusions and resident-level adjustment.
The Consequences of Risk Adjustment in the Medicare Advantage Program
In How Does Risk Selection Respond to Risk Adjustment? Evidence for the Medicare Advantage Program (NBER Working Paper No. 16977), Jason Brown, Mark Duggan, Ilyana Kuziemko, and William Woolston study individual-level data for 55,000 people in the Medicare Current Beneficiary Survey (MCBS) from the period 1994 to 2006. Prior to risk adjustment, insurers simply had an incentive to enroll individuals with low costs. After risk adjustment, insurers instead had an incentive to enroll individuals with low costs conditional on their medical conditions. The main reason for this is that the risk adjustment formula pays the plans the average cost of the average person in a particular risk category. The authors demonstrate that, because individuals with less costly cases of diabetes and other health conditions enrolled in MA plans after the move to risk adjustment, overpayments to these plans actually increased.
This may result in fines of up to $250,000, a prison term or both, if you are convicted of public assistance fraud. In addition you will not be able to get benefits for 12 months the first time, 24 months the second time, and permanently the third time that you provide false or inaccurate information.
Florida Medicare Providers & Carriers
Florida Medicare providers offer services at different prices depending mainly on location and network availability. A Medicare provider is a medical practitioner or supplier who falls into a carrier network and performs services or offers supplies that are reimbursed by Medicare. To become a Medicare provider in Florida, a practitioner must submit an application, have a valid state medical license, and comply with United States non-discrimination standards. Examples of providers include fee-for-service providers, pharmacists, physicians, and skilled nursing facilities.
Medicare Supplement Insurance in Florida
Medicare Supplement Specialists is not connected with or endorsed by the United States Government or the federal Medicare program. Copyright (c) 2010. medicaresupplementspecialists.com. All rights reserved.
FLORIDA MEDICAID APPLICATION
Medicaid serves primarily low-income families, children, related caretakers of dependent children, pregnant women, people age 65 and older, and adults and children with disabilities. Initially, the program was only available to people receiving cash assist ance Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI). During the late 1980s and early 1990s, Congress expanded the Medicaid program to include a broader range of people, including older adults, people with disabilities and pregnant women. While individuals receiving TANF and SSI cash assistance continue to be automatically eligible for Medicaid, these and other federal changes declines Medicaid eligibility from receipt of cash assistance.
Florida Medicare Part B Doctor’s Benefits
Florida residents who are eligible for Part B and do not have credible health coverage from an employer or union, should sign up for Medicare Part B as soon as they are eligible to avoid incurring a late enrollment penalty. For each 12-month period Part B enrollment is delayed, a 10% premium penalty (based on the standard Part B premium) would be added onto the monthly Part B premium amount.
Medicare Nursing Home Compare Results
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%.
Medicare Advantage Plan Pharmacies
KelseyCare Advantage’s pharmacy network offers limited access to pharmacies with preferred cost-sharing in urban and suburban areas within Texas. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost-sharing, please call 1-866-589-5222, 24 hours a day, 7 days a week. TTY/TDD users should call 1-888-206-8041 or consult the online pharmacy directory at www.kelseycareadvantage.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.
Because the Medicare system is standardized, Medicare Supplement coverage is identical with all companies. The only difference between companies is price. Medicare Supplements Made Easy provides you with free Medicare Supplement Insurance Quotes from the leading Insurance Companies.
Medicare News and Information
If you are approaching Medicare eligibility, or are already eligible, you know that figuring out your Medicare coverage options can be challenging. There are so many choices. How can you compare options and find the one that truly meets your needs?
Medicare Supplemental Insurance by 1
A Medicare Supplement Plan, or Medigap, is a type of medicare health insurance that is sold by private insurance companies and is specifically designed to help you by filling in the “gaps” of Original Medicare. In order to purchase a Medigap plan you must be enrolled in Medicare Part A and B, and you will continue to pay your monthly Part B premium. You would then pay your Medigap premium and as long as your premium gets paid you will have the benefit of guaranteed renewable coverage. What this means is that the insurance company cannot cancel your policy. There are several different plan types available to consider, but it is important to note that Medigap policies are “standardized.” This means that they are required to abide by the Federal and State laws that are put in place to protect you. The standardized policies must provide you with the same benefits no matter what company sells them and generally the only difference from company to company, if it is the same plan type, is the cost. Many couples would like to be covered under the same policy, but you and your spouse must each purchase your own individual policies. In some instances you might be allowed to purchase a Medicare Supplement plan that is guaranteed issue without any medical underwriting! This means that you cannot be denied coverage.
How to Sell Medicare Supplements
Medicare Supplement Open Enrollment Period The most popular time to purchase a Medicare Supplement insurance policy (also called a Medigap policy) is during the Medigap open enrollment period. This six month period begins on the first day of the month in which your client turns 65 or older and enrolls in Medicare Part B. During the Medicare supplement open enrollment period, you will not use medical underwriting. This means Medicare supplement companies can’t refuse to sell your client any Medigap policy that they offer, make them wait for coverage to start, or charge more for a Medigap policy because of health conditions. Clients are also provided a six month window prior to their Medicare A and B effective dates (their 65th birthday) to apply for a Medicare Supplement without underwriting. Medicare Supplement Guaranteed-Issue Guaranteed-issue periods are generally shorter than Open Enrollment, and allow seniors to switch Medicare Supplement policies for the best price for their age, without a waiting period and regardless of health condition. The Guaranteed-Issue period generally occurs when your client’s current health care plan is changing in a certain way, you are involuntarily losing your coverage, or in some cases when an insurance company may have their own Guaranteed-Issue situation. There are seven circumstances that could take place and cause Guaranteed-Issue: 1. Your client’s employer or union coverage that acts as a Medicare Supplement is ending 2. Your client’s Medicare Advantage plan is leaving the Medicare program, stopping service in their area, or they are moving out of the area the plan services. 3. Your client is moving out of you Medicare Select’s service area though they can keep their current policy, they want to change policies. 4. Your client’s Medicare Supplement company goes bankrupt or they lose their Medicare Supplement policy through no fault of their own 5. After enrolling in Medicare Advantage or PACE they decide they want to switch to original Medicare (and a Medicare Supplement) within a year of joining 6. Your client dropped their Medicare Supplement to switch to a Medicare Advantage plan or Medicare SELECT for the first time; however, if after less than a year they decide you want to switch back to a Medicare Supplement policy 7. Your client decides to drop their Medicare Supplement or Medicare Advantage plan because the company has not followed the guidelines or misled them in some way Medicare Supplement Underwriting If your client is not in an Open Enrollment or Guaranteed-Issue period, then their Medicare Supplement will be subject to underwriting. Underwriting is the “Yes/No” portion of the Medicare Supplement application process, with those who answer the most questions “No” having a better chance at receiving coverage. Some insurance companies also do a telephone interview to further go over the responses to the questions and decide if they will qualify for their Medicare Supplement.
Medicare.gov: the official U.S. government site for Medicare
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.
North Carolina SHIIP centers are there to help individuals and couples understand the variety of Medicare programs and the wide array of supplemental plans available. North Carolina SHIIP provides local counseling sessions as well as personal phone and office consultations for patients throughout the state, educating residents on the wide variety of medical care and insurance options available (which can vary from region to region), including:
North Carolina Medicare Supplement: North Carolina Medigap
There are many companies in North Carolina claiming to offer low prices in Medicare supplements, but it is most important to find a company that offers not only great prices but also exceptional customer service. Our company does both, providing some of the most competitve prices and helpful employees to answer all of your Medicare questions. By filling out the form today, you can recevie a free quote that will put you on the right path to the correct North Carolina Medicare Supplement plan for you!
North Carolina Medicare Advantage Plans with Part D (Prescription Drug) Coverage
The plans below offer Medicare Advantage and Part D coverage to North Carolina residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Blue Cross Blue Shield of North Carolina Medicare Supplement
Blue365 offers access to savings on items that Members may purchase directly from independent vendors, which are different from items that are covered under the policies with BCBSNC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither BCBSNC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
North Carolina Medicare Supplement Plans Coverage
This material is for information only. Plans may be subject to medical underwriting or other restrictions. Rates and benefits vary by location. Plans not available in all states. Pre-existing condition limitations may apply. This policy does not pay benefits for any service and supply of a type not covered by Medicare, including but not limited to dental care or treatment, eyeglasses and hearing aids. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.
Are you a Florida senior citizen who is trying to maximize your Medicare benefits? Just as each senior citizen has her own unique needs and preferences, insurers offer a variety of different ways to enjoy these hard-earned health benefits and even help you plan for medical expenses that original Medicare does not completely cover. At Secure Health Options, we want to help all Floridians find the right plan that assures them of convenient and affordable access to the best medical providers. You can request information on Medicare Advantage plans and Florida Medicare supplemental insurance in your own local area by entering your home ZIP code in the box at the top of this page. If you have questions or would like help signing up, be sure to give us a call.
Compare Medicare Advantage & Supplemental Plans
Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Florida Blue Medicare Advantage Plans
Florida Blue Medicare Advantage plans come from a company that has been helping people of this state access medical care since before World War II ended. The company evolved from both a local company and the oldest national health insurance company in the United States, Blue Cross. As time passed, the company has evolved even more to meet the changing needs of its customers and successive generations. As it has for the past 70 years, Florida Blue focuses on Florida consumers and leads the healthcare industry with innovation.
Medicare Advantage in Florida
Florida residents wishing to enroll in Medicare Advantage must already be enrolled or be eligible to enroll in Original Medicare, Part A and Part B. You are first able to join Original Medicare during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. If you don’t sign up for Medicare during your Initial Enrollment Period, you may subject to a late-enrollment penalty for as long as you remain enrolled in Medicare. You may enroll in Original Medicare at a later date, during the annual General Enrollment Period, which runs from from January 1 to March 31, but be aware that you would still have to pay the late-enrollment penalty fee.
Florida Medicare Advantage Plans with Part D (Prescription Drug) Coverage
The plans below offer Medicare Advantage and Part D coverage to Florida residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Medicare Plans for Different Needs
UnitedHealthcare is dedicated to helping people nationwide live healthier lives. Our goal is to simplify the health care experience, help you meet your health and wellness needs and carry on trusted relationships with care providers. We offer a wide range of Medicare Advantage, Medicare prescription drug and Medicare Special Needs Plans that might be a good fit for you.
How Medicare Advantage Plans work
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.
To qualify for this surgery, your doctor will have to provide detailed information and medical records showing that joint replacement is medically needed in your case. Even if your surgery is approved, you may have to pay the Part A and/or the Part B deductibles before Medicare will pay, plus you may have copayments due. Before scheduling any surgical procedure, it’s a good idea to get an estimate of costs and find out what your coverage options are.
Hip Replacement and Medicare coverage??? (medical, plan, hospital, doctor)
Barb, I had a total hip replacement on the left side last last June 2012 and wish I had done it sooner! I researched the surgeons who only do the anterior approach. It is much less invasive, zero chance of dislocation (unless you really mess up yourself by pivoting with your foot flat on the floor), not as much blood loss or complications etc., and a much easier recovery. I was in the hospital only 3 days, went to a rehab place for 5 days, but it was an awful place and I was not getting any PT etc., so I checked out of there and went home. Did not have any family support or care at home, except for the physical therapy (Medicare covers) at home, probably 9 times, I forget. Then outpatient PT to which I drove myself there. Was offered home health care, but didn’t need or want it, was doing fine after 3 weeks and driving. Look up doctors who specialize in the anterior method. Smaller incision high on the hip, no muscles are cut etc., excellent way to go. Mine is ceramic and titanium, they don’t do metal on metal anymore. With the old method you have a lot of strict precautions. Now I need to have the right hip done (which is now bone on bone, yikes), and will schedule it for March or so right here at home in NC; that way I’m good to go for the spring and summer best weather; and I know what to expect. I won’t go to any rehab/nursing center, better off at home with PT at the house. Those places are awful. Actually, the one I went to did some fraudulent Medicare billing and I’ve reported them. I never once got PT and they billed something like $1700 for PT which I never got, and something ridiculous for OT (occupational therapy which I never got). I had no choice about where to go for rehab, it was chosen on a first come first serve basis. (I did not have it done here in NC, had it done up north to be near family. haha.) So depending on where you live, if you want to go to rehab, visit the places and make sure they are clean and well rated. Most good hospitals and surgeons have a "Joint Center" and you have a private room, and great care. Choose the best surgeon you can find. Once you are recovered, probably within a month, you will wish you had it done sooner. No more pain.
Complication Rate for Hip/Knee Replacement Patients
To assign hospitals to performance categories, the hospital’s interval estimate is compared to the national hip/knee complication rate. If the interval estimate includes the national observed hip/knee complication rate, the hospital’s performance is in the “no different than national rate” category. If the entire interval estimate is below the national observed hip/knee complication rate, then the hospital is performing “better than national rate.” If the entire interval estimate is above the national observed hip/knee complication rate, its performance is “worse than national rate.” Hospitals with fewer than 25 eligible cases are placed into a separate category that indicates that the hospital doesn’t have enough cases to reliably tell how well the hospital is performing.
Medicare plans big payment changes for knee and hip replacements
Six years after end-of-life planning nearly derailed development of the Affordable Care Act amid charges of “death panels,” the Obama administration has revived a proposal to reimburse physicians for talking with their Medicare patients about how patients want to be cared for as they near death.
Medicare IDs best, worst hospitals for hip and knee replacements
Of the 95 hospitals where patients experienced difficulties after the operation, nine were rated having both high readmissions and high complication rates, none in Missouri or Illinois. Those hospitals were: Froedtert Hospital in Milwaukee; Grant Medical Center in Columbus, Ohio; Mercy St. Anne Hospital in Toledo, Ohio; Northwestern Memorial Hospital in Chicago; the Pennsylvania Hospital of the University of Pennsylvania Health System in Philadelphia; Peterson Regional Medical Center in Kerrville, Texas; Reston Hospital Center in Reston, Va.; Shannon Medical Center in San Angelo, Texas, and Southside Regional Medical Center in Petersburg, Va.
No Fooling: Mandatory Medicare Bundled Payments for Hip and Knee Replacements Start April 1
CMS encourages hospitals to enter into what it refers to as CCJR sharing arrangements with CCJR collaborators (including physicians and non-physician practitioners, skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, home health agencies, and outpatient therapy providers). Under such a written contract, the CCJR collaborator would agree to participate in specific quality and efficiency initiatives relating to the episodes in exchange for “gainsharing payments,” i.e., the hospital’s agreement to share a portion of any reconciliation payment and/or a portion of the hospital’s internal cost savings generated through such initiatives. A CCJR collaborator also may agree to pay the hospital an “alignment payment,” i.e., a portion of any repayment the hospital owes to CMS.
For questions about New Jersey Medicaid, call 1-800-356-1561 or your County Welfare Agency For questions about NJ FamilyCare call 1-800-701-0710 You can also get information by visiting NJHelps.org, where you can self-screen for eligibility for NJ FamilyCare/Medicaid, as well as for many other social service programs.
Medicare Information, Help, and Plan Enrollment
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.
New Jersey Medicaid Attorney
He met with me and explained all of my options for my mom, from at home/community care, assisted living, state, county and local programs for the elderly, financial eligibility for benefits, Medicaid qualification, pharmaceutical assistance, utility aid, Medicare and Veteran’s benefits, etc. While I felt overwhelmed by it all, Mr. Niemann clearly was in control of what could be done for Mom. We engaged him to make applications for subsidized at-home care and assistance through available grant programs and as part of his services to us, he is counseling us on a reverse mortgage, income and financial products to enhance Mom’s monthly income and to reduce her expenses. Mom would tell me to let Mr. Niemann make all the decisions although I am her Power of Attorney. I value so much his confident and generally caring manner. If you’re trying to help your Mom, Dad or family member deal with a life changing health condition, call Mr. Niemann. I’m glad I did and so is Mom.
New Jersey Office of the State Comptroller
The New Jersey “Medicaid Program Integrity and Protection Act”, C.30:4D-53 et seq. established the Office of the Medicaid Inspector General to detect, prevent, and investigate Medicaid fraud and abuse, recover improperly expended Medicaid funds, enforce Medicaid rules and regulations, audit cost reports and claims, and review quality of care given to Medicaid recipients. On June 29, 2010, Governor Chris Christie signed P.L. 2010, Chapter 33, which officially transferred these functions, powers and duties of the Office of the Medicaid Inspector General to the Office of the State Comptroller. The Office of the State Comptroller then created the Medicaid Fraud Division. The Division conducts investigations of fraud, waste and abuse, performs background checks on all Medicaid provider applicants, and coordinates oversight efforts among all State agencies which provide and administer Medicaid services and programs, including FamilyCare and Charity Care. The Medicaid Fraud Division also works to recover improperly expended Medicaid funds, enforces Medicaid rules and regulations, audits cost reports and claims, reviews the quality of care given to Medicaid recipients, and excludes or terminates providers from the Medicaid program where necessary. Additionally, the Division refers criminal prosecutions to the Attorney General’s office, issues recommendations for corrective or remedial actions to the Governor, President of the Senate, and Speaker of the General Assembly and conducts educational programs for Medicaid providers, vendors, contractors and recipients.
Department of Human Services
Through managed care, New Jersey Medicaid believes beneficiaries have better access to healthcare providers than they do through Medicaid’s traditional fee-for-service health insurance program. Health Plans are also able to provide a comprehensive package of preventive health services, that combined with the full range of Medicaid benefits, allows for the best healthcare possible.