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

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Source: medicare.gov

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

Quest Diagnostics announced Tuesday that it is outsourcing its revenue-cycle services to Optum, a giant UnitedHealth Group subsidiary, to reduce costs and improve cost transparency to customers. As part of the deal, Quest will become Optum’s primary vendor for member biometric screening services…
Source: modernhealthcare.com

Medicare Coverage Database – Centers for Medicare & Medicaid Services

Contextual Help & Page Help – Contextual Help is a new feature that provides users with the ability to receive onscreen help for specific elements on the page. To use the feature, click the "Contextual Help" link and move the mouse to the onscreen location of the associated page element. The user can turn the feature off when help is no longer required. Users who are unable to use this feature, or who prefer to have a link to a single page of help for the entire page, may continue to use the "Page Help" link to get assistance.
Source: cms.gov

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

Changes in the Use and Costs of Diagnostic Imaging Among Medicare Beneficiaries With Cancer, 1999

Financial Disclosures: Dr Curtis reported receiving research support from Allergan, Eli Lilly and Company, GlaxoSmithKline, Medtronic, Merck & Co, Johnson & Johnson (Ortho Biotech), Novartis, OSI Eyetech, and Sanofi-Aventis. Dr Curtis has made available online a detailed listing of financial disclosures (http://www.dcri.duke.edu/research/coi.jsp). Dr Schulman reported receiving research support from Actelion Pharmaceuticals, Allergan, Amgen, Arthritis Foundation, Astellas Pharma, Bristol-Myers Squibb, The Duke Endowment, Genentech, Inspire Pharmaceuticals, Johnson & Johnson, Kureha Corporation, Medtronic, Merck & Co, Nabi Biopharmaceuticals, National Patient Advocate Foundation, NovaCardia, Novartis, OSI Eyetech, Pfizer, Sanofi-Aventis, Scios, Tengion, Theravance, Thomson Healthcare, and Vertex Pharmaceuticals; receiving personal income for consulting from McKinsey & Company and the National Pharmaceutical Council; having equity in Alnylam Pharmaceuticals; having equity in and serving on the board of directors of Cancer Consultants Inc; and having equity in and serving on the executive board of Faculty Connection LLC. Dr Schulman has made available online a detailed listing of financial disclosures (http://www.dcri.duke.edu/research/coi.jsp). No other disclosures were reported.
Source: jamanetwork.com

The Facts on Medicare Spending and Financing

A number of changes to Medicare have been proposed that could help to address the health care spending challenges posed by the aging of the population, including: restructuring Medicare benefits and cost sharing; eliminating “first-dollar” Medigap coverage; further increasing Medicare premiums for beneficiaries with relatively high incomes; raising the Medicare eligibility age; shifting Medicare from a defined benefit structure to a “premium support” system; and accelerating the ACA’s delivery system reforms. At the same time, changes have been proposed to improve coverage under Medicare in order to limit the financial burden of health care costs on older Americans and younger beneficiaries with disabilities, though such changes would likely require additional spending. In addition to these potential changes, which would affect future spending levels, revenue options could also be considered to help finance care for Medicare’s growing and aging population.
Source: kff.org

Important: What are Medicare’s true administrative costs?

The Centers for Medicare and Medicaid Services (CMS) annually publishes two measures of Medicare’s administrative expenditures. One of these appears in the reports of the Medicare Boards of Trustees and the other in the National Health Expenditure Accounts (NHEA). The latest trustees’ report indicates Medicare’s administrative expenditures are 1 percent of total Medicare spending, while the latest NHEA indicates the figure is 6 percent. The debate about Medicare’s administrative expenditures, which emerged several years ago, reflects widespread confusion about these data. Critics of Medicare argue that the official reports on Medicare’s overhead ignore or hide numerous types of administrative spending, such as the cost of collecting taxes and Part B premiums. Defenders of Medicare claim the official statistics are accurate. But participants on both sides of this debate fail to cite the official documents and do not analyze CMS’s methodology. This article examines controversy over the methodology CMS uses to calculate the trustees’ and NHEA’s measures and the sources of confusion and ignorance about them. It concludes with a discussion of how the two measures should be used.
Source: pnhp.org

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

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

Find and compare Nursing Homes

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Source: medicare.gov

The Department of Medical Assistance Services. Medicaid for Virginia.

pdf To learn more about the services and people covered by Virginia Medicaid by State House district, please click on this. To learn more about the services and people covered by Virginia Medicaid by State Senate district, please click on this. Note: the average House district has 16% of its district enrolled in Medicaid. The average Senate district has 16% of its district enrolled in Medicaid. These figures are based on the original 2010 census population for Virginia: For more information about Medicaid and FAMIS health insurance coverage in Virginia including how to apply, go to www.coverva.org. You may also call Cover Virginia toll-free at 1-855-242-8282 (TDD 1-888-221-1590) to apply or get more information. In addition, you may contact the Department of Social Services www.dss.virginia.gov in the city or county where you live.
Source: virginia.gov

What Does Medicare Cover?

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Twenty percent of the Medicare-approved amount for some types of care. These are doctor’s appointments, physical therapy, diabetes supplies, durable medical equipment like commode chairs, wheelchairs, and other care. You have to meet your deductible first and then pay 20% of the services you receive.
Source: webmd.com

What does Medicare cover (Parts A, B, C, and D)?

companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
Source: medicareinteractive.org

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

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Source: medicare.gov

Medicare Coverage Database – Centers for Medicare & Medicaid Services

Contextual Help & Page Help – Contextual Help is a new feature that provides users with the ability to receive onscreen help for specific elements on the page. To use the feature, click the "Contextual Help" link and move the mouse to the onscreen location of the associated page element. The user can turn the feature off when help is no longer required. Users who are unable to use this feature, or who prefer to have a link to a single page of help for the entire page, may continue to use the "Page Help" link to get assistance.
Source: cms.gov

Original Medicare (Part A and B) Eligibility and Enrollment

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To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Source: cms.gov

Federal Poverty Level for Determining Eligibility for Medicare and Medicaid Benefits

If your income is under 135% FPL, there are other Medicare Savings Programs you can qualify for. One of these programs is the Qualifying Individual (QI) program, which pays your monthly Part B premium. The income limit for another Medicare Savings Program, Specified Low-Income Medicare Beneficiary (SLMB), is 120%, but the program provides the same benefit – payment of the monthly Part B premium.
Source: nolo.com

Medicare Supplemental Insurance — Which policy is best?

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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 Supplement Plans 2016

“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

How to compare Medigap policies

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Source: medicare.gov

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

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Which Medicare Supplement is the best?

Coverage: Do you want more cost sharing for lower premiums or do you want a policy that covers all the deductibles, coinsurance and copays that are left for a Medicare beneficiary to pay.  A Medigap Plan F is the most comprehensive plan on the market and usually will be the most expensive plan available, but it does provide security that any catastrophic incidents would be covered.
Source: medicareinsurancefinders.com

How U.S. News Picked the Best Medicare Plans for 2016

[Read: 5 Health Insurance Mistakes Costing You.]    More About Best Medicare Plans      In addition to rating insurers, U.S. News has republished the CMS star ratings for each Medicare Advantage plan and Part D plan in the country. Plans are searchable by ZIP code from the U.S. News Medicare homepage or the search box at the top of every page on Medicare. By default, Medicare Advantage plans with drug coverage are displayed, but you can click to see Part D plans only, or Medicare Advantage plans without drug coverage. Use the search refine drop-downs and check boxes on the left side to narrow down plans according to your criteria. Note, for example, there are Medicare Advantage plans with a $0 premium, though that is zero dollars on top of what a person on original Medicare already pays – that amount is automatically deducted from the person’s Social Security check.
Source: usnews.com

Supplements & other insurance

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Source: medicare.gov

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

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

Federal support of Teladoc is yet another negative sign for the Texas Medical Board. A federal judge already granted an injunction halting the telemedicine rules while Teladoc’s case moves forward, showing he believes the company will likely prevail in its fight against the state regulation.
Source: modernhealthcare.com

Medicare Coverage Database – Centers for Medicare & Medicaid Services

Contextual Help & Page Help – Contextual Help is a new feature that provides users with the ability to receive onscreen help for specific elements on the page. To use the feature, click the "Contextual Help" link and move the mouse to the onscreen location of the associated page element. The user can turn the feature off when help is no longer required. Users who are unable to use this feature, or who prefer to have a link to a single page of help for the entire page, may continue to use the "Page Help" link to get assistance.
Source: cms.gov

Original Medicare appeals

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Source: medicare.gov

Sterling Heights, Michigan Appeal Attorney :: The Audit Appeals Process :: Warren, Michigan Appellate Lawyer

Note: As with the redetermination level of appeal discussed above, the reconsideration level of appeal has a separate deadline that must be met in order to avoid recoupment of alleged overpayments by the CMS contractors. Specifically, recoupment can be stopped if the request is received by the CMS contractor within 60 days following the date of redetermination. If the request for reconsideration is not received by the CMS contractor within 60 days of the redetermination decision, recoupment can begin on day 76. It is also important to note that providers must present all evidence at the reconsideration level of appeal. If information is not submitted prior to the issuance of the Reconsideration decision, the provider will be precluded from presenting any additional evidence at the later stages of appeal unless the provider can demonstrate that it had “good cause” for failing to submit the information at the Reconsideration level.
Source: racattorneys.com

Medicare Appeals Process Forms

A party may appoint any individual, including an attorney, to act as his or her representative to help the party during the processing of a claim or claims and /or any appeals of claims. A representative may be appointed at any time during the appeals process. The party making the appointment and the individual accepting the appointment must either complete an appointment of representative form (CMS-1696, CMS-1696 Spanish) or use a conforming written instrument. If the form CMS-1696 is not used, the written request must contain all of the elements listed in 42 CFR 405.910. The appointment of representative is valid for one year from the date it is signed by both the party and the appointed representative. A detailed explanation of appointment of a representative can also be found in the CMS Internet Only Manual (IOM) 100-4, Chapter 29, section 270.
Source: findacode.com

Coventry Medicare: Grievances & Appeals

How do I submit a Part C Organization Determination to request coverage for medical services? You, your doctor, or representative can call, fax or mail your request to us. Phone and Fax: Our contact information (phone number, address, and fax number) is available to you on the contact us page of this website and in the plan’s Evidence of Coverage (EOC). You can also call us using the number on the back of your ID card. Fax: 855-788-3994 Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 What can I do if my Part C Organization Determination request is denied? If we don’t cover or pay for your benefits or services, you, your doctor, or representative can appeal our decision. You need to submit your name, address, member number and reason for appealing. Any evidence you want us to review, such as medical records, doctor’s letter or other information that explains why you need the item or services, can be submitted. Call your doctor if you need this information . For a standard appeal, mail or fax deliver your appeal to: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax: 855-788-3994 For an expedited appeal: Phone: 866-613-4977 Fax: 855-788-3994 How do I submit a Coverage Determination for my prescription drug? If you’re a member, you can request an exception if a drug has a prior authorization, quantity limit or step therapy. Not an Aetna member yet? You can call 1-877-988-3589 (TTY: 711) to get answers to your questions. You, your doctor, or representative can submit the online form, or download the form for your type of plan, and fax or mail deliver your request to us. You may also call us. Submit online form If we don’t currently cover your medication or you need prior authorization before we cover your medication, you can ask for this coverage by completing one of the forms below: First Health Part D Prescription Drug Plans Medicare Advantage Plans Fax: 1-800-639-9158 Mail: Part D – Medicare Appeals & Grievances P.O. Box 7773 London, KY 40742 Phone: Our phone numbers (standard and expedited) are on the contact us page of this website, in the plan’s Evidence of Coverage (EOC), and on your ID card. What can I do if my Coverage Determination is denied? If we deny your Prescription Drug request, you can appeal our decision. You, your doctor, or representative can submit the online form, or download the form below and mail or fax deliver it to us. Submit online form Download: Request for Redetermination of Medicare Prescription Drug Denial Fax: 1-800-535-4047 Mail: Part D Medicare Appeals & Grievances – Redeterminations P.O. Box 7773 London, KY 40742 If your request needs to be “Expedited” you can call or fax us. Expedited Phone Line: 1-800-536-6167 Expedited Fax Number: 1-800-535-4047 What can I do if I have a complaint (also called a “grievance”)? If you have a complaint about your medical or pharmacy coverage, you, your representative , or your doctor can call, fax, or write to us. For Part C Appeal and Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax #: 855-788-3994 For Part D Appeal & Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Fax #: 1-800-535-4047 Mail: Part D Appeal & Grievance P.O. Box 7773 London, KY 40742 You can contact the Office of the Medicare Ombudsman for help with a complaint, grievance, or information request. To learn more, visit https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html. How long does it take to get a decision? You can request either a “Standard” or “Expedited” (fast) decision process. If your health requires it, you can ask us to give you a "fast coverage decision". A "fast coverage decision" is called an "expedited coverage determination" or an “expedited organization determination”. When we give you our decision, we will use the "standard" deadlines unless we have agreed to use the "fast" deadlines. We will respond to your request no later than the below timeframes. Request for an Coventry Medicare Advantage Plan (Part C) Organization Determination  Standard Process = Pre-service: 14 days     Claims: 60 days Expedited Process = Pre-service: 72 hours     Claims: n/a Request for a Coventry Medicare Advantage Plan (Part C) Organization Determination Denial Standard Process = Pre-service: 30 days Claims: 60 days Expedited Process = Pre-service: 72 hours Claims: n/a Request for Prescription Drug Coverage Determination Standard Process= 72 hours Expedited Process= 24 hours Request for Redetermination for a Coventry Medicare Prescription Drug Denial Standard Process= 7 days Expedited Process= 72 hours Coventry Medicare Advantage Plan Grievance Standard Process= 30 days Expedited Process= 24 hours Prescription Drug Plan Grievance Standard Process= 30 days Expedited Process= 24 hours
Source: coventryhealthcare.com

Healthcare – Just Facts

Posted by:  :  Category: Medicare

[Under Medicare Part C] Most beneficiaries have the option to enroll in private health insurance plans that contract with Medicare to provide Part A and Part B medical services. The share of Medicare beneficiaries in such plans has risen rapidly in recent years, reaching 25.0 percent in 2010 from 12.4 percent in 2004. Plan costs for the standard benefit package can be significantly lower or higher than the corresponding cost for beneficiaries in the “traditional” or “fee-for-service” Medicare program, but prior to the Affordable Care Act [ACA, a.k.a. Obamacare], private plans were generally paid a higher average amount, and the additional payments were used to reduce enrollee cost-sharing requirements, provide extra benefits, and/or reduce Part B and Part D premiums. These benefit enhancements were valuable to enrollees but also resulted in higher Medicare costs overall and higher premiums for all Part B beneficiaries, not just those who were enrolled in MA plans. Under the ACA, payments to plans will be based on “benchmarks” in a range of 95 to 115 percent of fee-for-service Medicare costs, with bonus amounts payable for plans meeting high quality-of-care standards. (Prior to the ACA, the benchmark range was generally 100 to 140 percent of fee-for-service costs.) As these changes phase in during 2012-2017, the overall participation rate for private health plans is expected to decline from 25 percent in 2010 to about 15 percent in 2020.
Source: justfacts.com