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

Posted by:  :  Category: Medicare

Hospital stocks remained flat despite the Fed’s decision this week to hold interest rates steady for at least another month. The historic low levels of 0.25% to 0.5% are a plus for hospitals looking to expand or refinance. Hospitals, especially the not-for-profits, rely heavily on bond debt for…
Source: modernhealthcare.com

Health Insurance, Medicare Insurance and Dental Insurance

At Humana, we go beyond insurance. We help provide a roadmap to a healthier you. By taking a personalized look at your life and your health, we can help you find the perfect plan and achieve your goals. Start becoming your best you. Start with healthy.
Source: humana.com

Medicare Coverage for Air Ambulance

Posted by:  :  Category: Medicare

If Medicare doesn’t cover your ambulance trip, you have a right to appeal. An appeal is a special kind of complaint you make if you disagree with decisions made by Medicare. To file an appeal, carefully review your MSN. It will tell you why your bill wasn’t paid, how long you have to file an appeal, and what appeal steps you can take. If you decide to file an appeal, ask your doctor or provider for any information that might help your case. You should keep a copy of everything you send to Medicare as part of your appeal. If you need help filing an appeal, call 1-800-MEDICARE (1-800-633-4227) to get the number for the State Health Insurance Assistance Program in your state.
Source: usairambulance.net

Medicare Part B Overview: Coverage and Premiums

You’ll typically pay a premium for Medicare Part B unless you qualify for financial assistance. Because of this, you have the option of turning it down, although you might pay a late-enrollment penalty if you decide to enroll in Medicare Part B later on. This monthly Part B premium amount may vary from year to year. Remember, you must have both Part A and Part B if you decide to enroll in a Medicare Advantage plan.
Source: medicareconsumerguide.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 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

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.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

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

The Medicare Part D Prescription Drug Benefit

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

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

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

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

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare’s new payment system for physicians fast approaches. Modern Healthcare’s latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by MACRA.
Source: modernhealthcare.com

Medicare Eligibility Verification

Posted by:  :  Category: Medicare

eSolutions’ Medicare Eligibility Verification also features real-time change reporting. When you submit a new transaction, the tool will compare the new transaction to the patient’s most recent transaction processed in the last 90 days. Each field on the Coverage Detail Report is analyzed in real time. When there’s a change, the changed item(s) displays with light gray shading. Additionally, the date of the previous transaction (the one that the new transaction was compared to) is displayed in the header row of the report.
Source: esolutionsinc.com

Medicare eligibility verification

What makes traditional Medicare eligibility verification so time-consuming? Using the system known as Medicare Direct Data Entry or DDE, you can literally spend hours checking a patient’s history of Medicare coverage. For one thing, it’s an understatement to say that DDE isn’t very user-friendly. The interface is an old-style “green screen” – just like every computer 20 or 30 years ago! With this system, you need to access several sections of the DDE in order to get all of the relevant information for a patient for whom you are verifying Medicare eligibility. The information is not consolidated in one section.
Source: abilitynetwork.com

Check Medicare Eligibility at www.CheckMedicare.com.

1. 24 hour availability is not a guarantee of service uptime. It is merely hours of service operation under normal operating conditions.   2. Works Best with Internet Explorer 10 with a resolution of 1024×768 or higher. The newest versions of Chrome & Firefox are also supported.   3. Average response time is 3-6 seconds, but may be up to 1 minute during peak times. This response time is affected by various factors including, but not limited to, network congestion, CheckMedicare.com server load, and the status of the CMS Medicare HETS system. If you experience consistent response times over 6 seconds please feel free to contact CheckMedicare.com support for system status or assistance.   © 2009-2016 ICS Software, Ltd. All rights reserved. All other copyrights and trademarks are copyrights and trademarks of their respective owners. This disclaimer relates and applies to all pages and content served by ICS Software, Ltd.
Source: checkmedicare.com

Real Time Health Insurance Eligibility Verification, Medical Eligibility

DataLink’ s service is fantastic. We’ve had very few problems and the few we’ve had have been resolved quickly. Whether uploading large data files or manually entering the patient information, the system is easy to use and gives us the information we need. I expected DataLink’ s site to be similar to others – slow and time – consuming, which has not been the case. The overall ease of use and quick response times have far exceeded our expectations.
Source: datalinkms.com

How to Verify Medicaid Eligibility

Contact your local Medicaid office. This can be done by visiting the Families USA web site’s State Information page, linked in the Resources section. Click on your state. A box will pop up to the right of the map. Click on the “Government Links” link. Scroll down until you find the “State Government Links” text. Click on the link that directs you to your state’s Medicaid website. Search the website and find the contact information on the page. By contacting your local Medicaid office, you will be able to ask questions that relate to your eligibility in your specific state.
Source: ehow.com

How to Check Medicare Eligibility Online

Read over and analyze the results. If you are qualified for Medicare, it will explain exactly how and when you are eligible and any actions you need to take to access your benefits. This information is separated into three sections: General Enrollment, Part A Specific and Part B Specific. General Enrollment will give you essential enrollment information that you need to know, such as how to enroll if you are outside of the country, the dates you are eligible to enroll (called enrollment periods) and a quick summary of the Medicare benefits available to you. Part A and Part B Specific explain whether you are qualified for Part A and Part B and at what cost. It also specifies any regulations or stipulations that must be followed for enrollment purposes, such as enrollment periods or whether you may be at risk for a premium penalty if you delay enrollment. If you are not eligible immediately, the tool will tell you your prospective date of eligibility. For example, if your birth date is May 18, 1957 and you do not have a qualified disability, the tool will tell you that you are qualified for Medicare beginning May 1, 2022.
Source: ehow.com

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

Posted by:  :  Category: Medicare

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare’s new payment system for physicians fast approaches. Modern Healthcare’s latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by MACRA.
Source: modernhealthcare.com

How to Become a Medicare Provider

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

Does Medicare Cover Ionto?

Iontophoresis is a process in which electrically charged molecules or atoms are driven into tissue with an electrical field. Voltage provides the driving force. This is a constant attendance code requiring direct, one-on-one patient contact by the provider. Only the actual time of the provider’s direct contact with the patient is covered. If no objective and/or subjective improvement noted after 8 treatments, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of this modality. The efficacy of this modality should be met in at most 10-12 visits. Documentation must support the need for continued treatment with this modality for greater than 12 visits. This modality should be used in conjunction with therapeutic procedures. Coverage for iontophoresis when delivered by means of a ’24 hour patch’ is only for the time spent for the initial application and is generally covered for 1-2 visits to establish efficacy. Subsequent visits for reapplication generally do not require the skills of a licensed therapist and therefore are noncovered.
Source: nancybeckley.com

Search Results, Medicare.gov

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

Locating an Individual Provider Transaction Access Number (PTAN)

“The contractor shall not send an individual’s provider transaction access numbers (PTAN) to a group or organization (including the group’s authorized or delegated official). If a group/organization needs to know an individual provider’s PTAN, it must contact the provider directly for this information or have the individual provider request this information in writing from the contractor. If the individual provider requests his/her PTAN number, the contractor can mail it to the provider’s practice location. The contractor should never give this information over the phone.”
Source: custhelp.com

Obtain a previously issued PTAN

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

Centers for Medicare & Medicaid Services

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

Mandatory Insurer Reporting (NGHP)

Posted by:  :  Category: Medicare

Reporting is accomplished by either the submission of an electronic file of liability, no-fault, and workers’ compensation claim information, where the injured party is a Medicare beneficiary, or by entry of this claim information directly into a secure Web portal, depending on the volume of data to be submitted. Upon receipt of this information, CMS checks whether the injured party associated with the claim report is a Medicare beneficiary, and determines if the other insurance is primary to Medicare. CMS then uses this information in the Medicare claims payment process and, if Medicare paid first when it should not have, uses it to seek repayment from the other insurer or the Medicare beneficiary.
Source: cms.gov

Medicare reporting and recovery update: MMSEA Section 111 reporting

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 Home Health Compare

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 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: The Medicaid Project, California Medicaid Eligibility, Benefits

“A waiver allows the Department of Health Services (DHS) to waive Medi-Cal criteria for persons who would not be able to receive these Medi-Cal benefits otherwise. Services provided under a waiver are typically not part of the available benefit package under Medicaid or may be an extension of an existing benefit when there are pre-determined limits such as with therapy services. Home and Community Based Service (HCBS) waivers are creative alternatives, allowed under the federal law for states participating in Medicaid (Medi-Cal in California), to be implemented in the home community for certain Medi-Cal beneficiaries to avoid hospitalization or nursing facility placement… ” *source:
Source: quickbrochures.net

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

Medicare PPO Blue PlusRx (PPO)

Medicare PPO Blue PlusRx offers a Visitor/Travel Program that includes in-network benefits and cost-sharing when you receive treatment for covered services from participating Blue Medicare Advantage PPO network providers outside of Massachusetts in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia.
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