Medicare Claims Processing Manual

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Source: cms.gov

Welcome to Arkansas Medicaid

Posted by:  :  Category: Medicare

The Arkansas Department of Human Services (DHS), Division of Medical Services (DMS) is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written application for extension and amendment of the 1115 Demonstration waiver for the Health Care Independence Program and to hold public hearings to receive comments on the extension application to the Demonstration Waiver. The State anticipates submitting an application to amend the Demonstration in fall of 2016 to replace the Health Care Independence Program implemented under the current 1115 waiver authority with Arkansas Works, a program reflecting the features now under consideration by the Governor, the Arkansas Legislative Task Force on Healthcare Reform, and the Arkansas Legislature.
Source: ar.us

Welcome to Arkansas Medicaid

Use of this application is restricted to authorized users. User activity is monitored and recorded by system personnel. Anyone using this application expressly consents to such monitoring and recording. BE ADVISED: if possible criminal activity is detected, system records, along with certain personal information, may be provided to law enforcement officials.
Source: ar.us

Medicaid Expansion in Arkansas

Beneficiaries who make at least 6 non-consecutive monthly account contributions in a calendar year receive account credits that can be used to offset future QHP premiums (after enrollment in the Medicaid private option ends), employee contributions to ESI, or Medicare premiums (for those over age 64).  The credits will be distributed as cash once the beneficiary is no longer eligible for Medicaid as a new adult, if the beneficiary continues to reside in Arkansas.  For each month that they make a timely account contribution, beneficiaries accrue the lesser of their monthly contribution amount or $15, regardless of the amount of co-payments or co-insurance charged to the card.  Credits are capped at $200 and must be used within 2 years of accrual.
Source: kff.org

Office of the Medicaid Inspector General

Please take advantage of the new Pharmacy Self-Auditing Toolkit named “Pharmacy Self-Auditing:  Control Practices to Improve Medicaid Program Integrity and Quality” which is located on the Centers for Medicare & Medicaid Services (CMS) webpage. The toolkit emphasizes on areas of pharmacy that are prone to triggering audits that …   Read More >
Source: arkansas.gov

MyMedicare.gov: Secure Sign In

Posted by:  :  Category: Medicare

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Source: mymedicare.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

Welcome to Palmetto GBA eServices

You are accessing a U.S. Government information system, which includes: (1) this computer, (2) this computer network, (3) all computers connected to this network, and (4) all devices and storage media attached to this network or to a computer on this network. This information system is provided for U.S. Government-authorized use only. Unauthorized or improper use of this system may result in disciplinary action, as well as civil and criminal penalties. By using this information system, you understand and consent to the following:
Source: onlineproviderservices.com

Medicare Prescription Drug, Improvement, and Modernization Act

Posted by:  :  Category: Medicare

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from “nay” to “yea.” After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered “substantial and aggressive campaign support” which he had assumed included financial support.
Source: wikipedia.org

Medicare’s Therapeutic Shoe Bill Guide to Benefits and Shoe Selection

Which Codes do you Reference? – A5500 For diabetics only, fitting, preparation and supply of off-the-shelf depth inlay shoe manufactured to accommodate multi-density inserts, per shoe. A depth shoe is one that 1) has a full length, heel-to-toe filler that when removed Provides a minimum of 3/16” of additional depth used to accommodate custom-molded or customized inserts, 2) is made from leather or other suitable material of equal quality, 3) has some form of shoe closure and 4) is available in full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent. (The American last sizing schedule is the numerical shoe sizing system used for shoes in the United States.) This includes a shoe with or without an internally seamless toe. A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of Shore A 35 durometer or 3/16 inch material of Shore A 40 durometer (or higher), prefabricated, each. A5513 For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher. Includes arch filler and other shaping material, custom fabricated, each. Note: Medicare instructs that when a pair of shoes, inserts or modifications is provided, two units of service should be reported on the claim; when a single unit is furnished, report only a single unit and code with appropriate modifers to indicate whether the unit was for the right or left foot.
Source: apexfoot.com

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

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Source: medicare.gov

Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress 

In an effort to strengthen MA enrollee consumer protections, in June 2014, Congresswoman Rosa DeLauro (D-CT) and Senator Sherrod Brown (D-OH) introduced the Medicare Advantage Participant Bill of Rights Act of 2014 (H.R. 4998/S. 2552).  Senator Richard Blumenthal (D-CT) is a strong advocate and co-sponsor of the bill.  Among other things, this bill would prohibit MA plans from dropping providers during the middle of the plan year unless they can show cause, and would improve notice to plan enrollees about annual changes to provider networks before they commit to joining the plan. The Center for Medicare Advocacy supports this bill.
Source: medicareadvocacy.org

How to Bill Medicare for Home Health Services: 11 Steps

Medicare was enacted in 1965 to expand the Social Security Act by providing a hospital insurance program with supplemental medical benefits and extended medical assistance for the aged, survivors, and disabled, in addition to improving state public assistance programs. The insurance program is for people who have reached the age of 65 or have particular disabilities and those in the end stages of renal disease. Today, older Americans rely on it to pay for about half of all of their medical costs. One of the important provisions in Medicare coverage is home health care. This provision is intended to allow seniors to remain independent as long as possible. One study indicated that 90% of older Americans want to stay in their home as long as possible.
Source: wikihow.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 Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Medicare Supplemental Insurance Quotes

Medicare supplemental insurance plans are not only ideal in the sense that they help individuals to cover loose ends that may not be covered under Medicare, but these plans also maintain the rights and protections set forth under and individuals Medicare insurance plan. Additionally, one can maintain the relationship that they have with their current doctors, even if using a Medicare supplemental insurance plan, ensuring that you are comfortable with the medical attention that you are seeking. Supplemental plans work solely to aid individuals in increasing the benefits that they have under their medical insurance, as detailed on various pages through this website. It is important that you become knowledgeable in the current cost and benefits associated with your Medicare insurance plan, as well as the additional benefits that you may eligible for under a Medicare supplemental insurance plan.
Source: medicaresupplementalinsurance.co

Medicare Supplemental Insurance

When you buy insurance, any insurance, its purpose is to cover you for unexpected costs you could never cover yourself. You buy homeowners insurance to cover damage done by a fire or a storm or water damage done by a broken pipe. No one buys a homeowner’s policy that covers utilities or routine maintenance. Most people who own a house are used to paying for the cost of painting it. Homeowners expect to pay for the cost of replacing their roof every 20 years as well, even though the cost of a new roof on most houses would actually exceed the cost a Medicare patient would pay for the treatment for most cancers.
Source: truecostofhealthcare.net

Shopping For Medicare Supplemental Insurance

Health insurance from an employer, professional organization, government or military retiree plans. If you remain employed after your 65th birthday, you may be able to continue your group health insurance with your employer and may not need a Medicare Supplement insurance policy. Likewise, if you become eligible for Medicare but are covered by your working spouse’s health insurance, you may not need a Medicare Supplement Insurance policy. Retirees with group health plans from their employers may consider switching to individual Medicare Supplement insurance policies. If you are in this situation, it is important to review each option before making a decision.  Group retiree plans may not cost anything, or the cost may be lower than buying an individual Medicare Supplement insurance policy.
Source: vermont.gov

Supplements & other insurance

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Source: medicare.gov

Medicare Supplemental Insurance Plans

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

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

Medigap insurance plan options

1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,180 deductible before it covers anything. 2. Plan K has an “Out-of-Pocket” yearly limit of $4,960 (in 2016). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an “Out-of-Pocket” yearly limit of $2,480 (in 2016). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B co-insurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission.
Source: medicaresupplement.com

Medicare Supplement Plans

Some states may offer Medigap plan options to beneficiaries under 65 who qualify for Medicare because of disability or certain conditions (such as end-stage renal disease). Federal law doesn’t require states to sell Medicare Supplement insurance to beneficiaries under 65. However, depending on where you live, some states may offer Medigap coverage to beneficiaries under 65; eligibility and the specific available options may vary by state. If you’re a Medicare beneficiary under 65 and interested in purchasing Medicare Supplement insurance, contact your state insurance department to learn if you’re eligible for Medigap coverage in your state.
Source: ehealthinsurance.com

Get Medicare Supplemental Insurance Plan Quotes

As long as you enroll during this six-month Medigap Open Enrollment Period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for coverage to begin. However, you may have to wait up to six months for coverage of a pre-existing condition. Original Medicare will still cover that health problem even if your Medicare Supplement plan doesn’t cover your out-of-pocket costs.
Source: ehealthmedicare.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Senior Health Insurance Information Program

Posted by:  :  Category: Medicare

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Source: la.gov

State of Oregon: Medicare Help

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Source: oregon.gov

St. Louis Insurance Specialists

Health insurance experts provide sound advice Senior Health Solutions has answers when you seek information regarding senior health plans. We take the time to evaluate your specific situation and plan your finances and health insurance according to your needs. Being a customer-centered office gives us the opportunity to take the time necessary to get to know you, your needs. We are the largest provider for Medicare Advantage insurance in St. Louis, yet pride ourselves on offering personalized attention to each and every client.
Source: seniorhealthsolutions.net

CommunityCare of Oklahoma Health Insurance Plans

CommunityCare is proud to offer Senior Health Plan, a program created especially for Medicare beneficiaries. CommunityCare Senior Health Plan is a Federally-Qualified HMO with a Medicare contract and is owned by Saint Francis Health System and St. John Health System in Tulsa (other physicians and providers are available in our network). Senior Health Plan’s contract with CMS is renewed annually.
Source: ccok.com

Australia’s Leading Health Insurance Provider

Posted by:  :  Category: Medicare

Not only do we offer cover better suited to every kind of family, for kids we provide no hospital excess and 100% back on included extras at Members’ Choice providers as part of our Growing Family and Settled Families packaged covers~. So you can take the best care of your most important people.
Source: com.au

Medicare Advantage: Private Health Insurance Through Medicare

Medicare Advantage plans may give you some discounts or pay for services that Original Medicare may not cover. However, Medicare Advantage plans are administered by private health insurers and you’ll be required to follow your plan’s rules. Original Medicare allows you to see just about any doctor and go to any hospital that accepts Medicare , which most providers accept. With Medicare Advantage plans, you’re typically restricted to the doctors and hospitals included in the plan’s network. You might need referrals to see a specialist.
Source: webmd.com

Medicaid, Medicare, and Private Insurance

Medicaid is funded by state and federal money. It is for people with low income who meet certain eligibility requirements and programs vary from state-to-state. The program mostly covers children, pregnant women, disabled adults, and seniors. Applications for the Florida Medicaid Program are made through the Department of Children and Families. Visit www.myflfamilies.com or call their toll-free number
Source: floridahealthfinder.gov

What is covered by Medicare?

Medicare is the basis of Australia’s health care system and covers many health care costs. You can choose whether to have Medicare cover only, or a combination of Medicare and private health insurance. Citizens and most permanent Australian residents are eligible for Medicare.
Source: gov.au

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

Posted by:  :  Category: Medicare

A list of 161 hospitals or hospital groups, ranked by the five-year change in readmissions penalties, 2013-17. Institutions are all members of America’s Essential Hospitals. Readmissions penalties are assigned by CMS Certification Number, so in hospital groups that share a single number, only the…
Source: modernhealthcare.com

Australian Government Department of Human Services

This information was printed Wednesday 31 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

Does Medicare ever cover dental services?

Posted by:  :  Category: Medicare

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

Dental Insurance for Seniors on Medicare

As with any insurance, it’s a good idea to purchase a dental plan before you’re facing a crisis. By buying dental insurance for seniors before problems arise, you’ll generally get a better rate. However, if you already suspect that you need serious dental work, it still makes sense to apply. That’s because once you’re approved, the plan may potentially save you some money by allowing you to purchase the dental services you need at the insurance company’s lower, negotiated rates. But be warned: you may pay much higher premiums or be rejected outright if dental problems have already manifest themselves.
Source: medicarewire.com

What’s not covered by Part A & Part B?

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Source: medicare.gov

Dental Insurance, Individual Vision Plan, Senior, Medicare Supplement

MWG Insurance Mall is the premier health insurance site online. Here, you’ll find great support in your search for Medicare supplemental insurance, dental insurance, and many other types of coverage. We strive to make our site as accessible as possible. Find a solution for your health insurance needs by relying on us to find the perfect senior life insurance plan, vision plan, or dental coverage. If you require further guidance, reach out to us.
Source: mwginsurancemall.com