Blue Advantage (PPO) Overview

Posted by:  :  Category: Medicare

Unlike Original Medicare, with a Blue Advantage plan, medical, hospital and prescription drug  coverage is included. Instead of relying on Medicare Parts A and B to cover hospital and medical  expenses, and a separate Part D plan for prescription drugs, everything is conveniently covered by one simple and effective plan. With affordable monthly premiums, Blue Advantage gives you the peace of mind, convenience, and value that comes from knowing that you’re covered by one comprehensive plan.
Source: bcbsalmedicare.com

Michigan Medicare Health Insurance Plans

Medicare is a health insurance program run by the government for people age 65 and older, and for people under 65 with certain disabilities. Understanding more about Medicare will make it easier to choose the right plan. Our Medicare 101 section has resources to help you do that.
Source: bcbsm.com

How Medicare Advantage Plans work

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

Humana, Cigna hit by lower 2017 Medicare star ratings

Posted by:  :  Category: Medicare

Humana and Cigna saw stock prices fall Wednesday after the CMS released its latest star ratings that showed declines in both insurers’ Medicare quality measures. The companies said the lower ratings follow a recent CMS audit that resulted in sanctions for Cigna. Overall, more Medicare Advantage programs received top quality ratings from the CMS for their 2017 plans than in previous years. The agency reported that nearly 70% of Medicare Advantage enrollees would be in plans that received at least four stars. However, the average star rating declined slightly, according to data released Wednesday. Shares of Humana fell 5% Wednesday after CMS reported that the percentage of Medicare Advantage members in Humana plans with four stars or higher fell by half, from 78% a year ago to 37%. The insurer said it would appeal the ratings and raised its full-year guidance, arguing the scores do not reflect its current business. Aetna, Humana’s partner in a huge merger currently being challenged by the U.S. Justice Department, also saw its stock prices tumble despite Aetna’s own star ratings, which grew 4 percentage points from last year. The CMS reported 91% of Aetna’s members are enrolled in four-star plans. Cigna, meanwhile, which has spent nearly a year trying to resolve problems in its Medicare Advantage plans, had only 20% of its members in plans rated four stars or higher. On Wednesday, Cigna shares fell 2.4% to $121.96. “We do not believe that these stars ratings reflect the quality offerings Cigna HealthSpring provides to beneficiaries,” the company said in a Securities and Exchange Commission filing. “We will work fully with the CMS through their process to ensure that they have the information and analysis needed to calculate final Stars ratings that more accurately reflect our performance.” The star ratings for the first time incorporated socio-economic information about plan enrollees. The change was announced after pressure from health plans and the release of studies showing patients eligible for both Medicaid and Medicare scored consistently worse than other enrollees on performance measures. A total of 208 Medicare Advantage plans with prescription drug coverage for 2017 scored four stars or higher. They have a combined enrollment of about 68% of all enrollees. That is up from 179 plans in 2016 and 158 plans in 2015. The average star rating for all 364 contracts was four. The performance of Part D standalone prescription drug plans also improved slightly. Almost half of the plans received at least four stars, representing about 41% of enrollees. Enrollment in Medicare Advantage plans next year is expected to be at an all-time high of about 18 million, which is about one-third of all Medicare enrollees, according to the CMS. Plans receive a star rating of one to five based on quality and performance measures in categories such as outcomes, patient experience and access. Plans that receive a score of four or higher receive a 5% bonus payment. Those that consistently receive less than three stars can be eliminated from the program. The CMS levied sanctions against Cigna last year. That banned the company from marketing and selling its Medicare Advantage policies to new beneficiaries. The CMS said Cigna plans “posed serious threats to the health and safety of Medicare beneficiaries.” For example, Cigna inappropriately denied medical care and prescription drugs to its members. Earlier this week, Cigna announced the retirement of Herbert Fritch, who oversees its Medicare business, Cigna-HealthSpring. Cigna faces other challenges as it, along with Anthem, which is trying to acquire Cigna, fend off an antitrust challenge. The two companies are accusing each other of breaching terms of their merger agreement, according to legal filings.
Source: modernhealthcare.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

Check the status of a claim

Posted by:  :  Category: Medicare

Check your Medicare Summary Notice (MSN). The MSN is a notice that people with Original Medicare get in the mail every 3 months. It shows all your Part A and Part B-covered services or supplies that providers and suppliers billed to Medicare during a 3-month period, what Medicare paid, and the maximum amount you may owe the provider. Learn more about the MSN, and view a sample.
Source: medicare.gov

Submit a Medicare claim online

This information was printed Thursday 1 December 2016 from humanservices.gov.au/customer/enablers/submit-medicare-claim-online 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.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

Social Security/Medicare/Medicaid Articles

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Next Avenue covers America’s Entrepreneurs, showcasing the know-how and spirit of people over 50 who have started their own businesses or hope to do so. The section is sponsored by the Richard M. Schulze Family Foundation and EIX, Entrepreneur & Innovation Exchange.
Source: nextavenue.org

Check Your Application Status

Blue Advantage (PPO) is a Medicare-approved PPO plan. Enrollment in Blue Advantage (PPO) depends on CMS contract renewal. BlueRx (PDP) is a Medicare-approved Part D plan. Enrollment in BlueRx (PDP) depends on CMS contract renewal. C Plus is a Medicare Select Plan.
Source: bcbsalmedicare.com

The United States Social Security Administration

Today, there are nearly 5.4 million Americans living with Alzheimer’s disease. While most people associate the disease with old age, there are 200,000 Americans under the age of 65 living with it today…
Source: ssa.gov

Center Comments on Medicare Reimbursement for Skilled Nursing Facilities 

Posted by:  :  Category: Medicare

Research on the treatment of beneficiaries with hip fractures found enormous changes in care settings and costs following the implementation of PPS.  One study found that before PPS, patients received rehabilitation in the hospital and generally went home, either directly from the hospital or following a short stay in a SNF.  After PPS, hospital lengths of stay declined from 22 days to 13 days and the percentage of residents discharged to SNFs increased from 38% to 60%.  The expectation was that patients could get the same rehabilitation services in SNFs that they had received in acute care hospitals, but at lower cost.  This did not prove true.  After PPS, the researchers found that, for various reasons, “rehabilitation therapy within the nursing homes was less effective than inpatient therapy before PPS.”  The outcomes for patients with hip fracture were worse following PPS.  Instead of getting therapy and returning home, patients were more likely to be in the nursing home a full year after their hip fracture; a 200% increase in the rate of nursing home residence was reported by the study after PPS was implemented.  John F. Fitzgerald, M.D., et al, “The Care of Elderly Patients with Hip Fracture,” New England Journal of Medicine 319(21):1392-1397 (Nov. 24, 1988).  The researchers called this finding “alarming” and their most important finding.  Services were not the same in the different settings.
Source: medicareadvocacy.org

The Outpatient Medicare Physician Fee Schedule

Audiology and speech-language pathology services under Medicare Part B (outpatient) have reimbursement rates established by the Medicare Physician Fee Schedule (MPFS) regardless of provider setting, except for outpatient audiology services provided in hospitals. This site provides information on the MPFS for audiologists and speech-language pathologists, including in-depth analysis of relevant policy changes and revisions to the fee schedule, Medicare Part B payment rules, geographic adjustment calculations, and new developments. The fee schedule is updated annually by the Centers for Medicare and Medicaid Services (CMS).
Source: asha.org

Brooklyn surgeon convicted of Medicare fraud, faces 40 years

Posted by:  :  Category: Medicare

Ahmed, 49, who had offices in Brooklyn and Long Island, waived his right to have the jury decide how much restitution he must pay the government and the amount will be calculated by Federal Judge Dora Irizarry before his sentencing.
Source: nydailynews.com

Brooklyn surgeon in Medicare billing scheme preyed on ‘elderly’

Ahmed, 51, allegedly took advantage of the Medicare system which places trust in doctors to submit truthful claims, billing the government provider of medical insurance for $85 million for some 5,000 surgical procedures from 2011 to 2013. Ahmed treated patients at his offices and hospitals in Brooklyn and Long Island.
Source: nydailynews.com

Medicaid and the Medicare Savings Programs 2016

Applications for these programs may be obtained from the Medicaid office at the local (county) Department of Social Services. Or, you may print the application form from the link below. All applications for the Medicare Savings Program must be mailed to the local Department of Social Services where you live. The phone number and address for the local Department of Social Services may be found in the government pages of the telephone book.
Source: ny.gov

Medicare News and Information

Posted by:  :  Category: Medicare

If you are approaching Medicare eligibility, or are already eligible, you know that figuring out your Medicare coverage options can be challenging. There are so many choices. How can you compare options and find the one that truly meets your needs?
Source: medicare.org

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

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 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

Tufts Health Plan Medicare Preferred

Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Tufts Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Source: tuftsmedicarepreferred.org

Find the Right Medicare Plan

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Source: cigna.com

Integrate Medicare Medicaid benefits

Posted by:  :  Category: Medicare

Approximately 182,000 Ohioans are covered by both Medicare (because they are over age 65 or disabled) and Medicaid (because they have low income). Medicaid and Medicare are designed and managed with almost no connection to each other, and the long-term care services, behavioral health services and physical health services that are provided to individuals who are eligible for both programs are poorly coordinated. In 2012, Ohio Medicaid launched a new integrated care delivery system (ICDS) called MyCare Ohio for most Medicare-Medicaid beneficiaries. The goal of MyCare is to manage the full continuum of Medicare and Medicaid benefits for Medicare-Medicaid enrollees, including long-term care and behavioral health care services.
Source: ohio.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

CMS Releases 2011 Medicare Fee Schedule Proposed Rule

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The RVUs for every dialysis code except two are increased for 2011, with CPT code 90967 (the daily code for infants experiences a 3.5% reduction), and code 90968 (the daily code for patients 2-11 years of age remaining stable) being the only exceptions.  Additionally, the RVUs for the inpatient dialysis code series do not reflect changes proposed as a result of review by the AMA’s Relative Value Update Committee (RUC), where RPA sought to have the relativity for these codes restored in light of changes in recent years to corresponding evaluation and management (E&M) services. [The high volume inpatient code, 90935, hemodialysis, single evaluation, at one time was equivalent to a level three hospital visit, but changes in the E&M code values disrupted the relativity and rendered it equivalent to a level two visit—RPA sought to restore the relativity.]  The positive news regarding RVUs extends to several high volume interventional nephrology codes as well.  For example the RVUs for CPT code 36870, percutaneous thrombectomy, AV fistula, was increased by 11.2%, and the RVUs for code 36589, removal of tunneled CV catheter, were increased by 8.5%.
Source: renalmd.org

PBS: Public Broadcasting Service

You’ve just tried to add this video to your Watchlist so you can watch it later. But first, we need you to sign-in to PBS using one of the services below. You’ll be able to manage videos in your Watchlist, keep track of your favorite shows, watch PBS in high definition, and much more!
Source: pbs.org

Beat the Winter Blues: Have an Indoor Beach Party

Take a break from eating and playing to create a few works of art. Here, three projects that will be fun for all. Sand Paintings You may not be able to draw in the sand but you can still draw with sand. Use a pencil to sketch a simple design (think stripes and patterns). Then, working one small section at a time, apply an even layer of glue to the places you want to fill — use a fingertip to spread it around. Pour sand over the glue, making sure to cover the entire area. Repeat until your paper is covered and then shake off the excess sand over a trash can. Once the glue is dry, seal your masterpiece with hairspray.
Source: grandparents.com

B A B Y L O N F L O R A L

We hand select our flowers daily and carry a large assortment of fresh orchids and tropicals along with seasonal picks. For special requests, call the day before and we’ll order what you want. We are happy to offer city-wide delivery and an association with a consortium of fine florists, offering outstanding floral design for nationwide and international delivery. If you want to make a purchase and your billing address and/or credit card is outside the United States, please call the shop to order.
Source: babylonfloral.com