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

Australian Government Department of Human Services

This information was printed Saturday 13 August 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 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

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Medicare Home Medical Equipment Qualifications

Posted by:  :  Category: Medicare

The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit.  For example, for patients with COPD, heart failure, or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.  Functional assessment is important for all patients. Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient. Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries.  The note must clearly indicate that a major reason for the visit was a mobility evaluation.  Physician Fee for Face-To-Face evaluation Due to the MMA requirement that the physician or treating practitioner create a written prescription and a regulatory requirement that the physician or treating practitioner prepare pertinent parts of the medical record for submission to the durable medical equipment supplier, the Centers for Medicare & Medicaid Services (CMS) has established the new G Code (G0372) to recognize additional physician services and resources required to establish and document the need for a PMD. CMS believes that the typical amount of additional physician services and resources involved is equivalent to the physician fee schedule relative values established for a level 1 office visit for an established patient (Current Procedural Terminology (CPT) code 99211). The payment amount for such a visit is $21.60 Code G0372 indicates that: – All of the information necessary to document the PMD prescription is included in the medical record. – The prescription, along with the supporting documentation, has been received by the PMD supplier within 45 days after the face-to-face examination. Effective October 25, 2005, G0372, will be used to recognize additional physician services and resources required to establish and document the need for the PMD, and are  added to the Medicare physician fee schedule.
Source: viennamedical.com

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

The Medicare Part D Prescription Drug Benefit

Posted by:  :  Category: Medicare

The Medicare Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for people on Medicare known as Part D, which went into effect in 2006. All 55 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Medicare drug benefit through private plans approved by the federal government. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2016 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.
Source: kff.org

Why are Medicare Supplement Plans E, H, I and J No Longer Available?

When discussing Medicare Supplement plans they are almost always referred to Medicare Supplement Plans “A” through “N”.  However, when you review an Outline of Coverage, which defines what each plan covers, there are certain Medicare Supplement plans that appear to be missing between “A” and “N”.  Specifically, Medicare Supplement Plans E, H, I and J are not listed on the Outline of Coverage.  Why?  Because as a result of the Medicare Modernization Act, Medicare Supplement Plans E, H, I and J are no longer available to purchase.  If you already had a Medicare Supplement Plan E, H, I and J prior to June 1, 2010, you were allowed to keep the plan.  However, at this point in time and considering all the changes in original Medicare coverage it might be a good time to shop and compare the different plans that have been added and find a more affordable and more appropriate Medicare Supplement plan.  A Medicare Pathways Benefit Advisor will assist you in reviewing your options for a more modernized Medicare Supplement plan.  If you still have a Medicare Supplement Plan E, H, I and J there are other plans available that will cover the gaps left by original Medicare Part A and Part B, but one that will not duplicate benefits already provided as standard coverage by original Medicare.
Source: medicarepathways.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: How to Bill J Codes Correctly by the “UNITS” with example

Example#1: J1100-Dexamethasone, 1 mg Your bottle says 4 mg/ml If you use 0.25 cc (1 mg) = 1 Unit If you use 0.5 cc (2 mg) = 2 Units If you use 0.75 cc (3 mg) = 3 Units If you use 1.0 cc (4 mg) = 4 Units Example#2 J1030 methylprednisolone acetate, 40 mg (Depo-Medrol) Your bottle says 40 mg/ml If you use 0.25 cc 10 mg = 1 Unit If you use 0.5 cc 20 mg = 1 Unit (J1020=methylprednisolone acetate, 20 mg ) If you use 0.75 cc 30 mg = 1 Unit If you use 1.0 cc 40 mg = 1 Unit Example#3 J3301 triamcinolone acetonide, (Kenalog-10, Kenalog-40) per 10 mg Your bottle says Kenalog 40 =40 mg/ml If you use 0.25 cc 10 mg/40 mg = 1 Unit If you use 0.5 cc 20 mg/40 mg = 2 Units If you use 0.75 cc 30 mg/40 mg = 3 Units If you use 1.0 cc 40 mg/40 mg = 4 Units Example#4 J0702 betamethasone acetate and betamethasone phosphate, per 3 mg (Celestone Soluspan 6 mg/ml) If you use 0.25 cc 1.5 mg/6 mg = 1 Unit If you use 0.5 cc 3 mg/6 mg = 1 Unit If you use 0.75 cc 4.5 mg/6 mg = 1 Unit If you use 1.0 cc 6 mg/6 mg = 2 Units
Source: medicarepaymentandreimbursement.com

Medical Billing and Coding Guidelines and tips to improve billing.: Medicare J codes list

Medical Billing Solution, Learn Medical Billing Process and Concept, Tips to become a best Medical Biller, Specialist. Medical Insurance Billing codes, Denial Guidelines. Usage of correct CPT and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and insurance eligibility and follow up How to Guide.
Source: whatismedicalinsurancebilling.org

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

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Medicare Hospital Compare Quality of Care

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

Electronic Health Records (EHR) Incentive Programs

The American Recovery and Reinvestment Act of 2009 (ARRA) (Pub.L. 111–5) was enacted on February 17, 2009. Title IV of Division B of ARRA amends Titles XVIII and XIX of the Social Security Act (the Act) by establishing incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs), and Medicare Advantage Organizations to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs). These incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and utilization of qualified EHRs.
Source: cms.gov

National Correct Coding Initiative Edits

The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association’s CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.
Source: cms.gov

FAQ: 2014 Medicare Therapy Cap

Posted by:  :  Category: Medicare

Do providers need to submit documentation for “automatic” exceptions from the therapy cap? No specific documentation is submitted for automatic process exceptions. The clinician is responsible for consulting guidance in the Medicare Manuals and in the professional literature to determine if the beneficiary may qualify for the automatic process exception. Medicare beneficiaries will be automatically excepted from the therapy cap and providers will not be required to submit documentation for an exception if the beneficiary meets the criteria for an automatic exception. Documentation justifying the services shall be submitted in response to any Additional Documentation Request (ADR) for claims that are selected for medical review. If medical records are requested for review, clinicians may include, at their discretion, a summary that specifically addresses the justification for therapy cap exception.
Source: apta.org

FAQ: 2013 Medicare Therapy Cap

Does the therapy cap apply to critical access hospitals? For 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier). However, for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process.
Source: apta.org

Arizona Medicare Supplement: Arizona Medigap

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There are plenty of companies out there advertising supplemental insurance in Arizona, but how do you know you are picking the right one? First and foremost, you have to make sure that they have competitive prices, as well as a knowledgeable and respectable staff. Arizona Medicare Supplements provides both of those things, as we serve seniors with Arizona Medigap Coverage or Arizona Medicare Supplement policies. We strive to provide affordable rates as well as complete customer service both before and after the sale.
Source: arizonamedicaresupplements.com

Affordable Medicare Plans

Medicare can be quite overwhelming as you sort through your options and try to figure out what healthcare you need. For many of us, it’s the first time we really have to read the fine print, compare plans and understand the different options. But don’t worry, we’ve done the hard work for you and summarized Medicare in simple terms to help you find your best options. Once you have a level of comprehension under your belt, shop and compare Medicare plans to make sure you’re getting the best prices and coverage.
Source: medicare-plans.org

Medicare Rehab in Arizona

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming
Source: sober-solutions.com

Arizona Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The plans below offer Medicare Advantage and Part D coverage to Arizona 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

Get a Free Medicare Advantage Kit

Posted by:  :  Category: Medicare

If you are turning 65 soon and/or are eligible for a Special Needs plan (including Medicaid eligibility), you may qualify for a WellCare Medicare Advantage Plan today! Now you can manage your health and enjoy life, just like Gloria.
Source: wellcarenow.com

Do You Qualify For A Medicare Advantage Plan

You may still qualify for a Special Election Period to choose a new health plan if you have lost healthcare coverage or have had any other health status change recently. Call today to find out if you are eligible: (877) 841-6072 (TTY 711). If you do not elect a Medicare Advantage plan like WellCare during this time, you may be automatically enrolled into Original Medicare.
Source: wellcarenow.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 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 Advantage PPO Plans

The Medicare Part B premium. If you enrolled in Part B before 2016, you’ll pay $104.90. You’ll pay the standard premium of $121.80 in 2016 if any of the following situations applies: You enrolled in Part B for the first time in 2016; you get billed directly for your Part B premiums; you aren’t currently getting Social Security or Railroad Retirement benefits; and/or you have both Medicare and Medicaid, and Medicaid pays for your premiums. You may also pay a higher monthly premium if your adjusted modified gross income from your tax return two years ago is above a certain amount, or if you owe a late-enrollment penalty for Part B.
Source: ehealthmedicare.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

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

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

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Australian Government Department of Human Services

This information was printed Friday 12 August 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