How to Become a Medicare Provider

Posted by:  :  Category: Medicare

A completed Medicare provider application goes to the appropriate state agency, which checks the application and supporting documents for completeness and accuracy. For a health-care facility, the agency will provide a time frame in which you can expect an unannounced inspection to verify that your facility meets Medicare standards. Although an inspection is standard during enrollment, state agencies have the authority to conduct random unannounced inspections at any time. Once verifications and inspections are complete, the agency makes a recommendation and forwards the applications and results to the CMS for final approval or rejection.
Source: ehow.com

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

With a clinic that provides mental and physical care to transgender children and teens, UCSF is not an unwelcoming place by any means. But starting Monday, it and any other provider, healthcare organization or insurer in the U.S. that accepts federal funding are required by an HHS rule to adhere to…
Source: modernhealthcare.com

Application status lookup tool

Posted by:  :  Category: Medicare

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Source: fcso.com

Appeals status lookup tool

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Source: fcso.com

Difference between the Medicare Provider Numbers

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

Medicare reporting and recovery update: MMSEA Section 111 reporting

Posted by:  :  Category: Medicare

Risk Management Write-offs – Providers, physicians, or other suppliers who write off some or all of their own charges will report these transactions to Medicare as part of their normal billing processes. They do not need to separately submit a Section 111 report. But if those providers, physicians, or other suppliers accept and pay the bills of others, then those transactions must be reported through Section 111 as ORM or TPOC, whichever applies. In situations where the provider also wants to assume the patient’s co-payment obligation to ensure they have no out-of-pocket expense, they may do so by providing the patient a cash amount that is the equivalent of the co-insurance and/or deductible and then report that amount as a TPOC. But all providers are cautioned that the CMS rules in this area are complex and providers are urged to seek compliance guidance before engaging in a pattern or practice of waiving co-insurance and deductibles. 
Source: lexology.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

Mandatory Insurer Reporting for Group Health Plans (GHP)

The purpose of Section 111 reporting is to enable Medicare to correctly pay for the health insurance benefits of Medicare beneficiaries by determining primary versus secondary payer responsibility. Section 111 authorizes CMS and GHP RREs to electronically exchange health insurance benefit entitlement information. On a quarterly basis, an RRE must submit a file of information about employees and dependents who are Medicare beneficiaries with employer GHP coverage that may be primary to Medicare. In exchange, CMS provides the RRE with Medicare entitlement and enrollment information for those individuals in the GHP that can be identified as Medicare beneficiaries. This mutual data exchange helps to ensure that claims will be paid by the appropriate organization at first billing. The Section 111 GHP reporting process also includes an option to exchange prescription drug coverage information to coordinate benefits related to Medicare Part D.
Source: cms.gov

Medicare Advantage California

Posted by:  :  Category: Medicare

*All information submitted is private and not shared with third parties. We have a no spam or solicitation policy. All data is used expressly by medicareadvantagecalifornia.com and qualified associated medicare brokers to provide consumers with requested California Medicare Advantage information and assistance. By clicking on ‘Submit’, you consent to receiving a phone call and/or email from a licensed insurance representative regarding Medicare Advantage, Medicare Supplement and / or Medicare Drug Plans. When calling our toll free number you will be connected to a qualified licensed agent to assist you.
Source: medicareadvantagecalifornia.com

California Medicaid: eligibility, enrollment and benefits

Medicaid expansion has raised concerns about overburdening the health care system with a flood of new patients and challenging the financial viability of the program. An Oregon study released in early 2014 reinforced those fears. The study showed more use of primary care and about a 40 percent increase in emergency room visits among the newly insured. However, a recent study by the UCLA Center for Health Policy Research found that the spike in emergency room use was temporary — dropping by two-thirds after two years. The study also found that primary care use did not climb in response to the drop off of emergency room use — meaning overall utilization tapered off. Lead author Jerry Kominski summarized the study this way: “What our findings say to the country is (that) concerns about Medicaid expansion being financially unsustainable into the future are unfounded.”
Source: healthinsurance.org

California Medicare Supplement Plans

Beneficiaries may enroll in a Medicare Supplement plan in California during their six-month Medigap Open Enrollment Period, beginning on the first day of the month that they are 65 or older and enrolled in Medicare Part B. During this time, beneficiaries aren’t subject to medical underwriting, which means they cannot be charged higher premiums or denied coverage based solely on medical history or a current medical condition. However, if a beneficiary adds or changes a Medicare Supplement plan at any other time, medical underwriting guidelines will generally apply.
Source: ehealthmedicare.com

Blue Medicare PPO and Blue Medicare HMO Providers

Posted by:  :  Category: Medicare

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Source: bcbsnc.com

Medicare PPO Blue PlusRx (PPO)

You do not currently have end-stage renal disease (ESRD). If you initiated dialysis treatments for ESRD but have recovered your normal kidney function and no longer require a regular course of dialysis to maintain life, or have had a successful kidney transplant, or are currently a member of Blue Cross Blue Shield of Massachusetts, you may still join the plan. In addition, if you were a member of a Medicare Advantage plan that terminated its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.
Source: bluecrossma.com

Blue Cross Medicare Advantage (PPO) Network Participation

If you are located in Bastrop, Bexar, Burnet, Caldwell, Chambers, Collin, Dallas, Denton, Fayette, Fort Bend, Hardin, Harris, Hays, Jefferson, Lee, Liberty, Montgomery, Tarrant, Travis, or Williamson counties, Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan.
Source: bcbstx.com

Highmark Direct :: Medicare Information

Posted by:  :  Category: Medicare

Highmark is a registered mark of Highmark Inc. Highmark Choice Company, Highmark Senior Health Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal. Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company are independent licensees of the Blue Cross and Blue Shield Association.
Source: highmarkdirect.com

Medicare Supplement Plans

There are no fees associated with requesting Medicare Supplement Insurance comparisons, and you are under no obligation. If you have questions, and/or need advice you can contact one of our Licensed Medicare Supplement Insurance Specialists at 1-855-593-0069.
Source: directmedsup.com

Medicare Direct Data Entry (DDE)

Say good-bye to modems, password re-sets, and disconnects. Manage your own MAC credentials, get support for multiple submitter IDs, and benefit from complete visibility to Medicare claim submissions and eligibility verification, with built-in EDI tracking capability.
Source: abilitynetwork.com

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

What’s Medicare Supplement Insurance (Medigap)?

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

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 Supplemental Insurance compare rates and view plans

We provide Medigap / Medicare Supplemental Insurance to all seniors throughout the United States of America. Use our website to view and compare rates of multiple plans without entering any personal information. Our Medicare Supplemental Insurance comparison chart is a great tool to aid you in identifying the best Medigap Supplemental Insurance carrier to meet your needs. Once you have identified a Medicare Supplemental Insurance plan, you can either print out a Medicare Supplemental Insurance application, or call one of our professional agents to help guide you through your Medigap Insurance application.
Source: seniorhealthdirect.com

Direct Mail Leads for Medicare Supplement, Final Expense and More

Send a mailer to the names available on our accurate and qualified lists using our turn key lead services. Names to mail with age and income selection, forms, printing, bulk rate outgoing shipping, response postage and handling, scanning, uploading and data entry into TLLM are all included in the price you are given. If you would like to select additional demographics or duplicate lists we can add those options to your order. All leads returned are EXCLUSIVE to you and your order. The households (not just the names) you mail are also protected for at least 90 days giving you plenty of time to receive and work your leads.
Source: targetleads.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

Medicare Guidance for SLP Services in Skilled Nursing Facilities (SNFs)

Resistance to ordering videofluoroscopic or FEES studies for Part A patients may arise because the cost of the procedure (and transportation) is paid by the SNF out of the patient’s per diem rate (called Consolidated Billing). The SLP must clearly justify the need for an instrumental assessment to identify the cause and severity of dysphagia, not only to identify possible aspiration risk and appropriate texture, but to identify effective compensatory strategies or treatment techniques that would be incorporated in the Plan of Care. In some cases, instrumental studies may not be warranted if clinical indicators suggest that the study is not likely to provide beneficial information (see ASHA document Clinical Indicators for Instrumental Assessment). Instrumental studies can potentially save money by preventing patients from being placed on unnecessarily restrictive diets or alternative feedings (Martin-Harris & Logemann, 2000, Clinical utility of the modified barium swallow. Dysphagia, 141, 136–141.) (Note that in most states an in-house FEES procedure requires a physician, nurse practitioner, physician assistant, or clinical nurse specialist to be immediately available.)
Source: asha.org

Medicare Coverage Guidelines

*By clicking this button I hereby authorize Hoveround to call me on the residential or wireless telephone number I provided above. I understand and agree to be called with information on Hoveround’s products and services, and that automated telephone technology may be used including autodialing and/or prerecorded calls to contact me. I understand that consent is not a condition of purchase. Certain restrictions apply. Not available in all locations. Call for details.
Source: hoveround.com

Guidelines and Recommendations

A national coalition consisting of healthcare professionals and patients with end stage renal disease (ESRD) was formed in 2005 to increase the rate of hepatitis B, influenza, and pneumococcal immunizations in patients and staff in the dialysis setting.
Source: cdc.gov

Medicare Coverage of Speech

This area of the Reimbursement site provides information on the major aspects of Medicare related to audiology and speech-language pathology services, including Medicare coverage guidelines and reimbursement rates.
Source: asha.org

Medicare Home Health Guidelines

1. The need for homecare services must be for treatment of an illness or injury and require the skills of a nurse or therapist with specialized knowledge and training not expected from non-medical individuals. 2. The patient’s condition must be such that the services of the nurse/therapist are expected to support the patient’s ability to achieve individual treatment goals. 3. Nursing services are recognized for the purposes of teaching and training, direct care, and/or assessment and observation. 4. Therapy services, in general, must be based on the presence of functional goals that would be unlikely for the patient to achieve without skilled therapy.
Source: comprehensivehomehealth.com

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.
Source: medicare.com

Medicare Insurance Guidelines

Both Medicare and private health insurance plans pay for a large portion or sometimes even all costs associated with many types of medical equipment used in the home. This type of equipment is referred to as durable medical equipment or home medical equipment. The guide below will help you understand the Medicare guidelines related to home medical equipment. Most health insurance plans have similar rules to Medicare, but you should know that all private health insurance plans vary and the specific rules of your plan may differ from these Medicare guidelines. We accept most of the major health insurance plans. We would be happy to work with you and your insurance company to help you understand how your plan works as it relates to home medical equipment needed by yoBoth Medicare and private health insurance plans pay for a large portion or sometimes even all costs associated with many types of medical equipment used in the home. This type of equipment is referred to as durable medical equipment or home medical equipment. The guide below will help you understand the Medicare guidelines related to home medical equipment. Most health insurance plans have similar rules to Medicare, but you should know that all private health insurance plans vary and the specific rules of your plan may differ from these Medicare guidelines. We accept most of the major health insurance plans. We would be happy to work with you and your insurance company to help you understand how your plan works as it relates to home medical equipment needed by you or a loved one.
Source: aeroflowinc.com

Medicare CoPs and Interpretive Guidelines

Medicare interpretive guidelines are used by sate survey agencies (also known as SAs, which are usually state departments of health) to ascertain healthcare facilities’ compliance with the CoP. Such SAs survey healthcare facilities on two conditions: to determine the facility’s eligibility to participate in the Medicare program if it is not otherwise accredited by a “deemed status” entity such as the Joint Commission on the Accreditation of Hospital Organizations (JCAHO), and to audit healthcare facilities already accredited. According to the Government Accountability Office (GAO), SAs survey about 5 percent of a state’s hospitals in a given year. Medicare has provided SAs such interpretive guidelines for many years; however, CMS’ action to publish them online in May 2004 has brought increased scrutiny to the guidelines by AANA, CRNAs and hospitals. The importance of the interpretive guidelines to CRNAs is that at a practical level SA surveyors use them to ascertain facilities’ compliance with the CoP. Interpretive guidelines are identified either by the citation of their respective CoP in the Code of Federal Regulations, or by their heading or “Tag” number under which they appear in their respective CMS manual or appendix.
Source: aana.com

ConnectiCare Physician & Provider Manual

ConnectiCare follows CMS guidelines for codes that are subject to multiple procedure reduction as indicated in the Physician Relative Value Unit file at www.cms.gov. See Medicare Status Codes discussed earlier in this section. Diagnostic Imaging Code Families: Effective August 15, 2013, the 11 diagnostic imaging code families under the Multiple Procedure Payment Reduction on the Technical Component will be consolidated into a single family. This consolidation of imaging code families is consistent with CMS’ January 1, 2011, guidelines, please refer to
Source: connecticare.com

Rhode Island Division of Elderly Affairs: Programs

Medicare is the nation’s health insurance program for people 65 and older, and younger people who are disabled or who have end stage renal disease. Medicare consists of four parts–Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Insurance Plans) and MedicarePart D (Medicare Prescription Drug Plans). Almost all persons over age 65 are automatically entitled to Medicare Part A if they or their spouse are eligible for Social Security or Railroad Retirement.
Source: ri.gov

Medicare Supplement Insurance Quote Engine

Posted by:  :  Category: Medicare

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.
Source: bestmedicaresupplement.com

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.
Source: medicare.com

Fidelis Care > Products > Medicare Advantage and Dual Advantage > Overview

Posted by:  :  Category: Medicare

A: Medicare Advantage, also referred to as “Part C” coverage, is a different way to get your Medicare coverage. You still have Medicare Part A (Hospital) and Part B (Medical) coverage, but most of your Medicare-covered services will be paid by Medicare Advantage. You or someone on your behalf must continue to pay your monthly Part B premium, as well as any Medicare Advantage premium.
Source: fideliscare.org

Fidelis Care Health Insurance

Fidelis offers health plans for individuals, Medicare eligible beneficiaries and Medicaid eligible people. They provide free or low-cost health insurance through a variety of health programs that help cover preventive care, prenatal care, labs and immunizations, emergency care, and more.
Source: healthplanone.com

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

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 provider/supplier specialty codes

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Source: fcso.com