LabCorp Cheats Medicare, Costs Billions, Whistleblower Suit Alleges

Posted by:  :  Category: Medicare

This summer, the California state attorney general announced a $49.5 million settlement with LabCorp after allegations that it, and other labs, had overcharged the state’s Medicare program while providing kickbacks to doctors, hospitals and clinics that referred MediCal patients. In May, the attorney general settled with Quest Diagnostics for $241 million in what a press release describes as the same alleged practice.
Source: huffingtonpost.com

Kindred HealthCare Settles Whistleblower Lawsuit Alleging Kickbacks

RehabCare Group Inc, RehabCare Group East Inc. and Rehab Systems of Missouri and management company Health Systems, part of Kindred HealthCare Inc. have agreed to pay the Government $30 million in order to resolve allegations that they violated the False Claims Act by paying kickbacks for  patient referrals.  The lawsuit alleged that between March 2006 and December 2011, RehabCare arranged with Rehab Systems to obtain contracts to provide therapy to patients in approximately 60 nursing homes and in exchange Rehab Systems would retain part of the revenue received as the result of the referral.  “Health care providers that attempt to profit from illegal kickbacks will be held accountable,” said Assistant Attorney General for the Justice Department’s Civil Division Stuart F. Delery.  “We will continue to advocate for the appropriate use of Medicare funds and the proper care of our senior citizens.”
Source: medicare-fraud.net

Healthcare Whistleblower Cases, Tycko & Zavareei, Healthcare Fraud

A number of laws, including the so-called Stark laws and Anti-Kickback laws, generally prohibit the giving of money or other financial incentives (such as gifts) to doctors or hospitals in exchange for referrals or for the prescription of particular pharmaceuticals or supplies. These rules are intended to assure that doctors and other healthcare providers make decisions for their patients based solely upon medical necessity, and not because of some unlawful financial gain. Violations of the Stark and Anti-Kickback laws can result in false claims because, when a provider submits a claim to Medicare or Medicaid, the provider certifies that it has not violated these laws. Thus, if a healthcare provider is receiving kickbacks or is involved in an unlawful financial arrangement, the provider is also violating the False Claims Act, and could be subject to a qui tam lawsuit.
Source: fraudfighters.net

CarePlus Health Plans (Florida Medicare) Doctors: Book Online By Insurance, Reviews & ZIP

Posted by:  :  Category: Medicare

Managing your healthcare is easier than ever before with Zocdoc. Just search for a doctor in your insurance network, see available times, and book an appointment on the spot! You can read real doctor reviews from other patients, see the doctor’s background and education, view photos of the office, and more. It’s simple, secure, and free!
Source: zocdoc.com

FL Medicare Plan Wins 5 Stars

The state has such a competitive market that many plans charge no premium, including CarePlus’ five-star plans and some other companies’ plans that won 4 1/2 stars. In fact, in some counties plans with high ratings even reimburse Medicare beneficiaries for some of their Part B monthly premium of $104.90 — a deal that’s almost unheard-of elsewhere in the country.
Source: usf.edu

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.
Source: usnews.com

Your Medicare Number May Not Be Your Social Security Number by Tom Margenau

Posted by:  :  Category: Medicare

This issue exists because the Health Care Financing Administration, the agency that runs the Medicare program, chose a long time ago to simply use the Social Security claim number as the Medicare number. This really was never much of a problem until recently when retiring baby boomers started employing various Social Security "maximizing" strategies that allow them to switch from benefits on one account to benefits on another account. And that means that those retirees will go through a series of Social Security claim numbers up until the age of 70.
Source: creators.com

Claim Status Request and Response

Providers have a number of options to obtain claim status information from Medicare contractors: •Providers can call the provider help lines for their local Part A and Part B Medicare Administrative Contractor (MAC) and ask to speak to a customer service representative. •Providers can enter data via Interactive Voice Response (IVR) telephone systems operated by Medicare contractors. •Providers can enter claim status queries via direct data entry screens maintained by Medicare contractors. •Providers can send a Health Care Claim Status Request (276 transaction) electronically and receive a Health Care Claim Status Response (277 transaction) back from Medicare. The electronic 276/277 process is recommended since many providers are able to automatically generate and submit 276 queries as needed, eliminating the need for manual entry of individual queries or calls to a contractor to obtain this information. Submission of 276 queries and issuance of 276 responses should be less expensive for both providers and for Medicare. In addition, the 277 response is designed to enable automatic posting of the status information to patient accounts, again eliminating the need for manual data entry by provider staff members. If unsure whether your software is able to automatically generate 276 queries or to automatically post 277 responses, you should contact your software vendor or billing service.
Source: cms.gov

Coventry Medicare: Advantra (HMO/PPO)

Posted by:  :  Category: Medicare

Whether you are an employer, health care provider, someone interested in enrolling, or already a current 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

Medicare Supplement Plans (Medigap Plans) and other Medicare / Health Insurance Plans

A Medicare Supplement plan is a health insurance policy sold by private insurance companies in your state. It provides additional protection for what is not covered by Original Medicare. This insurance is specifically designed to fill the “gaps” in Medicare Part A and Part B coverage.
Source: libertymedicare.com

Pennsylvania Medicare Supplement Plans

The best time to enroll is during the six-month Medigap Open Enrollment Period (OEP). The OEP begins on the first day of the month that a beneficiary is age 65 or older and enrolled in Medicare Part B. During the OEP, a beneficiary has the guaranteed issue right to enroll in a plan of their choosing without undergoing medical underwriting, and insurers cannot charge more, or deny coverage completely during this period. Note: Even during this six-month period, insurers may have the ability to impose a waiting period for pre-existing conditions.
Source: ehealthmedicare.com

Coventry Medicare: Advantra (HMO/PPO)

To market/sell Coventry’s Medicare Advantage MA/MAPD plans, agents must successfully complete: 1. The AHIP Medicare marketing training and test; 2. The Coventry Core training and test (includes certification credit for agents who wish to market/sell First Health Part D plans); and 3. A health plan-specific product training and test. The above AHIP and Coventry Core certification requirements can be accessed online from the Coventry Broker Portal. Contact your local Coventry health plan team for information on product-specific training and testing designed to assist you with additional marketing our local Health Plan products. Contact the Coventry Broker Services Department (BSD) at 1-866-714-9301 (TTY: 711) if you have questions regarding online training and certification, or email the BSD at BrokerSupport@aetna.com.
Source: coventryhealthcare.com

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

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

Healthcare business news, research, data and events from Modern Healthcare

Modern Healthcare is proud to present the 100 companies and organizations that have been named to its Best Places to Work in Healthcare for 2016. Modern Healthcare will reveal the ranked order of the 100 Best Places to Work at an awards dinner on Oct. 6. Find out which firms made this year’s list.
Source: modernhealthcare.com

Australian Government Department of Human Services

This information was printed Wednesday 13 July 2016 from humanservices.gov.au/ 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

Medicare Insurance denial code, reason, action and appeal

How to work on Medicare insurance denial code and find the reason and how to appeal the claim. Medical billing denial and claim adjustment reason code. Sample appeal letter for denial claim. complete process of denial Management process.Medicare denial codes and solutions. Way to submitting clean claim. CO, PR and OA codes
Source: insuranceclaimdenialappeal.com

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

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.
Source: medicaresolutions.com

Medicare Advantage HMO Plans

Your initial enrollment in Medicare is time sensitive. The Initial Enrollment Period is your first chance to enroll in Medicare. It’s the three months before your 65th birthday month, the month of your birthday, and the three months after your birthday month. This is not an advertisement on behalf of any Medicare Advantage health plan or plans. For information about Medicare, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227) 24-hours, 7 days a week.
Source: suttermedicalfoundation.org

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.
Source: uhcmedicaresolutions.com

Medicare Supplemental Insurance Plans

Posted by:  :  Category: Medicare

Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. If you’re considering a Medicare supplement plan, talking to an agent/producer may offer the direct assistance you’re looking for.
Source: aarpmedicaresupplement.com

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?
Source: medicare.org

Medicare Supplement Plans & Medigap Plans

A Medicare Supplement plan (also called a Medigap policy) is private health insurance designed to supplement Original Medicare coverage. Medicare Supplement insurance helps pay some of the health care costs (or “gaps”) that are not covered by Original Medicare, such as copays, coinsurance, and deductibles. All Medicare Supplement plans must follow federal and state laws. The standardized policies that can be offered by Medicare Supplement insurance companies are identified by the letters A through N. Medicare Supplement plans do not replace Original Medicare; they only work to supplement Original Medicare benefits. Medicare supplement plans typically do not cover long-term care, vision, dental, hearing aids, eyeglasses, or private nursing.
Source: healthnet.com

Medicare Supplement (Medigap) Insurance Plans

MedSupp plans can help pay Original Medicare’s copayments and deductibles. Each type of plan offers a different level of coverage, and is named with a different letter (such as Plan A). The plans are standardized, so that all plans of the same letter offer the same benefits. In other words, the benefits for a Medicare Supplement Plan D enrollee in Rhode Island are the same for a Medicare Supplement Plan D enrollee in Tennessee. However, the premiums can differ among these private insurance companies.
Source: planprescriber.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

Billing Medicare, TRICARE And Medicaid

Posted by:  :  Category: Medicare

Medicare eligibility and enrollment The Medicare ID card and ID number Initial Enrollment Period Special enrollment period Premiums Deductibles and Copayment Medicare Part A Inpatient hospital benefits Skilled nursing care facility Hospice Continuous home care Respite care Medicare Part B Covered screening services Foreign travel Deductibles and co-insurance Assignment Participation and non-participation Limiting charge Clinical laboratory tests Ambulance service Hospital emergency room HPSA – Health Professional Shortage Areas Telehealth Medicare secondary payer Private contracts with providers Medigap Medicare Advantage Plans Medical Savings Account Private fee for service plans Medicare for people who are working Medicare and COBRA Medicaid History of Medicaid Requirements to receive federal funding for Medicaid Nursing facilities Covered outpatient drugs Medicaid fee for service Medicaid managed care Tricare History of Tricare Tricare Standard Tricare Prime US Family Health Plan Tricare Reserve Select Tricare Reserve Retired Tricare for Life Tricare Young Adult
Source: medicalbillingstudycourse.com

Differences Between TRICARE and MEDICARE

The aim of TRICARE is to provide those with links to the military with civilian health care. Interestingly, TRICARE doesn’t apply only to service members, but also to veterans, to the families of veterans and in some cases to civilian employees of the military. In essence, the program is there to ensure that people within the military and with ties to the military have more options when it comes to health care. TRICARE has gone through a number of changes since its foundation as CHAMPUS and beyond, so it can get a little confusing. The program can be broken down as follows:
Source: militaryauthority.com

Medical Benefits in Retirement – TRICARE For Life and Medicare

Part B covers most of the costs associated with physician fees, lab fees and durable medical equipment costs. Typically, Part B will pay 80 percent of the costs of these services, and leave you with 20 percent of the tab, though some services have a higher coinsurance amount. You’re automatically enrolled when you turn 65, in most cases. There is a premium for Part B coverage, though: $99.90 per month. There’s also an annual deductible of $140 every year.
Source: militaryauthority.com

TRICARE Supplemental Health Insurance Plans

FINAL REGULATION EXCERPT- One commenter asked if active civil service employees could suspend their FEHB coverage to use TRlCARE or TRlCARE-for-Life. The regulation does not allow employees to suspend their coverage. This is because employees have always had the option of canceling their coverage with the right to reenroll in the FEHB Program during a future Open Season, or immediately if they involuntarily lose TRICARE coverage. In the past, annuitants, survivors, and former spouses never had the option to reenroll in the F EHB Program after leaving for TRlCARE. Our new regulation creates this authority.
Source: tricareinsurance.com

Dental Coverage Under Medicare

Posted by:  :  Category: Medicare

For complete dental coverage, you can shop online at www.ehealthinsurance.com to learn about and buy an individual dental insurance plan that fits your personal needs. You may also have group dental insurance available, if either you or your spouse is employed. Be sure to read the plans carefully. Some dental plans require you to stay within a network of dental care providers. The premiums may be a bit higher for this type of plan, but the costs are offset by lower out-of-pocket fees, like copayments, coinsurance, and deductibles, mainly because network dentists usually agree to charge discounted rates to members of the dental plan. Other plans let you go to any licensed dental professional, but you may have to pay more at the time of service.
Source: ehealthmedicare.com

How to Get Dental and Vision Care Coverage When You Have Medicare

Some companies offer their Medicare supplement insurance plan members special coverage options for dental and vision care. Some may also offer insured members a discount program to help save money on dental and vision care. These offerings are not included in Medicare supplement insurance plan benefits. Rather, they are additional options that may be offered to insured members by some insurance companies.
Source: medicaremadeclear.com

Does Medicare ever cover dental services?

will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings, or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have teeth pulled (extracted) as preparation for a medical procedure, Medicare will not cover the cost of implants or dentures (complete or partial/bridge); you will be responsible for the full cost.
Source: medicareinteractive.org

Medicare Dental Insurance

Dental insurance coverage is one of the most common questions for seniors after they settle their Medicare Supplemental Insurance and Medicare Part D coverage. "How about dental" almost always follows the Medicare Supplement Insurance, and drug plan enrollment. Unfortunately Medicare has no dental insurance coverage. Discount Dental plans, Dental, Vision, and Hearing combinations, or Dental only plans are available in most areas. We believe the first and second choice provide the best value. The following information will help you compare these two options.
Source: medicaredentalcenter.com

Colorado Medicare Vision Coverage and Dental Plans

This information is available for free in other languages. Please call our Customer Service number at 888-282-1420 (TTY dial 711). Hours are 8am – 8pm, 7 days/week, Oct. 1–Feb.14, and 8am – 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario  de 8am – 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am – 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre. This page was last updated: 1/4/2016.  Please call to confirm you have the most up to date information about our Medicare Cost plans. Medicare Disclaimers RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. H0602_MS_MC400WEB_RMHP2 Pending.
Source: rmhp.org

Welcome to Medicare GenerationRx (Employer PDP)

Posted by:  :  Category: Medicare

Medicare GenerationRx™ (Employer PDP) is offered nationally in all 50 states, the District of Columbia, and the U.S. Territories. This prescription drug plan is a group plan underwritten by Transamerica Life Insurance Company (Rutland, VT).
Source: medicaregenerationrx.com

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

Medicare Part D Plans, Prescription Drug Plan (PDP)

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. ©2015 Aetna Inc. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members. This information is available for free in other languages. Please call our customer service number at 1-866-865-0662 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (TTY: 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-866-865-0662 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1º de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-866-865-0662 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30, if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery. Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
Source: coventryhealthcare.com

Medicare Part D Formulary, List of PDP Drugs

Medicare Part B covered drugs include a limited number of prescription drugs such as those you get in a hospital outpatient department under certain circumstances, injected drugs you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment (like a nebulizer or infusion pump). Certain diabetic supplies, such as: monitors, test strips and lancets are covered under Part B.  Medicare Part B drugs include, but are not limited to, the following types of drugs:
Source: coventryhealthcare.com

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.
Source: medicaresolutions.com