Proper Billing for Various Medicare Advantage HMO Claims

Posted by:  :  Category: Medicare

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

Documentation of Skilled Versus Unskilled Care for Medicare Beneficiaries: Speech

Medicare guidelines state that all services must be medically necessary and be provided at a level of complexity and sophistication that requires a speech-language pathologist to perform the tasks. They further stipulate that the interventions provided “require the expertise, knowledge, clinical judgment, decision making and abilities of a therapist that assistants, qualified personnel, caretakers or the patient cannot provide independently” (Medicare Benefit Policy Manual, Chapter 15, Section 220.3B [PDF]).
Source: asha.org

Florida Blue Medicare Advantage Plans for 2017

Are you a Florida senior citizen who is trying to maximize your Medicare benefits? Just as each senior citizen has her own unique needs and preferences, insurers offer a variety of different ways to enjoy these hard-earned health benefits and even help you plan for medical expenses that original Medicare does not completely cover. At Secure Health Options, we want to help all Floridians find the right plan that assures them of convenient and affordable access to the best medical providers. You can request information on 2017 Medicare Advantage plans and Florida Medicare supplemental insurance in your own local area by entering your home ZIP code in the box at the top of this page. If you have questions or would like help signing up, be sure to give us a call.
Source: floridamedicareadvantageplans.com

Medicare Supplement Insurance

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“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

Medicare Supplement Insurance & Medicare Advantage Personal Service

Medicare Supplement Insurance, also known as MediGap Insurance, is designed to help cover some of the medical costs that are not covered by Medicare. These Medigap coverage plans are available to anyone enrolled in Part A and B of Medicare. There is an open MediGap Insurance enrollment period for the first six months after you turn age 65, in which you do not need to qualify or answer any questions about your prior medical history.
Source: medigapadvisors.com

Precision Senior Marketing

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Source: psmbrokerage.com

Loyal American Medicare Supplement Insurance

Loyal American Life Insurance Company (LALIC) Cigna and Loyal American All Cigna products and services are provided by or through operating subsidiaries of Cigna Corporation, including Loyal American Life Insurance Company® located in Austin, Texas. Loyal American has been marketing insurance products for the needs of Americans since 1955.
Source: medicaresupplementspecialists.com

Medicare Advantage (Medicare Part C)

Posted by:  :  Category: Medicare

Medicare Advantage isn’t as complicated as it sounds. Before you decide on the type of Medicare insurance plan that may work for you, we recommend that you understand the coverage and costs, such as premiums, coinsurance, copayments, and deductibles. This isn’t guesswork; don’t be afraid to ask questions. A licensed eHealth insurance agent can help you find the answers. For help finding a plan to suit you, feel free to contact eHealth using the information below.
Source: medicareconsumerguide.com

Medicare Plans & Coverage: Part A, Part B, Part C, Part D

To be eligible for Medicare, one must be a legal permanent resident for the past five years or a U.S. citizen 65 years or older, or younger with a qualifying disability. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Source: medicareconsumerguide.com

The Cost Of A Cure: Revisiting Medicare Part D And Hepatitis C Drugs

Medicare Part D spending on hepatitis C drugs at the point of service is divided among plans, taxpayers, and beneficiaries, with shares varying according to the beneficiary’s spending level for the year to date. For example, in the phase between the deductible and the benefit’s initial coverage limit, beneficiary cost sharing for specialty drugs, such as those to treat hepatitis C, varies by plan from 25 percent to 33 percent, with the plan liable for the rest. After beneficiaries’ spending exceeds the benefit’s annual catastrophic threshold, their cost sharing is reduced to a statutorily required 5 percent. Out-of-pocket costs are an estimated $6,608 (Sovaldi) and $7,153 (Harvoni) per person at the point of sale for a full regimen, mostly as cost sharing in the catastrophic phase at 5 percent of the retail price of the drug, not the net (post-rebate) price. Above the catastrophic threshold, the plan is liable for 15 percent of the costs, and Medicare pays 80 percent of costs in the catastrophic phase in the form of reinsurance payments.
Source: healthaffairs.org

2016 Medicare Advantage (Part C) and Part D Final Rule Issued 

MA-PD Coordination Requirements for Drugs Covered Under Parts A, B, and D – CMS acknowledges that beneficiary access to needed drugs is impeded when a Medicare Advantage Prescription Drug plan (MA-PD) does not properly adjudicate claims for drugs that may be covered under Part A or B, rather than Part D, at the point of sale (POS).  Thus, CMS is requiring MA-PDs to establish and maintain a process to ensure that appropriate payment is assigned at the POS.  If a denial under Part D is based on the existence of coverage under Parts A or B, the MA-PD plan should authorize or provide the drug under that other benefit without requiring the enrollee to make a subsequent request for coverage under that other benefit.  According to the preamble of the final rule, CMS is amending 42 CFR §422.112(b)(7) to “require MA-PDs to coordinate with their network pharmacies and prescribers to improve existing processes and develop new ones in order to ensure that enrollees receive their Medicare-covered prescription medications, without delay, when they present at the network pharmacy.”[10] While CMS did not include beneficiary advocates’ request to require plans to treat a POS claim transaction as a request for a coverage determination under Part D, this new rule should nonetheless improve coordination of and access to drug coverage for MA-PD enrollees.
Source: medicareadvocacy.org

MEDICARE, Part A, B, C and D

The Original Medicare Plan (Medicare Part A & B) is available everywhere in the United States. It is the way everyone used to get Medicare benefits and is the way most people get their Medicare Part A and Part B benefits now. You may go to any doctor, specialist, or hospital that accepts Medicare. The Original Medicare Plan pays its share and your supplemental FEHB coverage often pays the difference and if you carry both Part A and B most FEHB plans waive the deductible, copayments and coinsurance. Some things are not covered under Original Medicare, like prescription drugs.
Source: federalretirement.net

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 2016 & 2017 costs at a glance

Posted by:  :  Category: Medicare

The standard Part B premium amount in 2017 will be $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount. This is because the Part B premium increased more than the cost-of-living increase for 2017 Social Security benefits. If you pay your Part B premium through your monthly Social Security benefit, you’ll pay less ($109 on average). Social Security will tell you the exact amount you will pay for Part B in 2017. You’ll pay the standard premium amount if:
Source: medicare.gov

2017 Medicare Premiums Could Jump 20% for Some People

For instance, people who aren’t receiving Social Security and who pay $121.80 a month for Medicare now may have to pay $149 a month, up 22%, according to estimates in the 2016 annual report issued by Medicare trustees in June. The percentage increase would be the same for people who pay higher premiums because of their income. That could mean a charge of $208.01 a month, up from $170.50, for someone with modified adjusted gross income between $85,000 and $107,000 (or between $170,000 and $214,000 on a joint tax return).
Source: time.com

Medicare Part B Monthly Premium 2017

Actually, these numbers are valid for most persons on Medicare. You will have to pay a higher premium if you filed an individual tax return last year and reported income over $85,000 or $170,000 for a joint return. Depending on the amount of your taxable income, you may have to pay between $187.50 up to the maximum Part B premium of $428.60 per person. Fortunately, income-related adjustments affect less than 5 percent of Medicare beneficiaries. If you have to pay a higher Part B premium because of your income, you should be notified by Social Security.
Source: medicareanswers.org

2016 Medicare Premiums and Deductibles

You may be able to avoid paying this late enrollment penalty if you delayed Medicare Part B because you had other health coverage, such as through an employer-sponsored group plan (either through your own or your spouse’s work). In this case, you can enroll through a Special Enrollment Period when you or your spouse stop working or that other health coverage ends, whichever comes first. If you have to pay a monthly premium for Medicare Part A, you may decide to delay enrollment in Part A as well and sign up during your Special Enrollment Period. If you enroll in Medicare with a Special Enrollment Period, you generally won’t have to pay a late enrollment penalty.
Source: medicare.com

AHIP Medicare + Fraud, Waste & Abuse Training: Login to the site

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Now there’s one single source for both Medicare and Fraud, Waste and Abuse (FWA) training. Our comprehensive online program gives you the background to make informed decisions on Medicare, including plan options, marketing, enrollment requirements, and FWA guidelines.
Source: ahipmedicaretraining.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

How can you look up a Medicare Provider Transaction Access Number?

Posted by:  :  Category: Medicare

An individual organization’s PTAN can only be provided to that organization, notes Wisconsin Physicians Service Government Health Administrators. Written requests for the PTAN must be submitted on letterhead and include the provider’s National Plan Identifier number, the associated address and the requester’s signature. The Medicare Administrative Contractor is prohibited from releasing the PTAN to another organization, to any other provider or over the phone.
Source: reference.com

How to Find a Medicare Number

Look at your social security card. Your social security number is the first part of your Medicare number for part A and B benefits. The second part is the letter A or B, depending on which benefit you are needing the number for. Part A is inpatient hospital benefits and Part B is outpatient medical benefits. For example, if your social security number is 111-22-3333, then your Medicare number for Part A benefits is 111-22-3333-A. If you do not have a social security card or your Medicare card, contact your local SSA office for a list of documents required for obtaining a replacement card.
Source: ehow.com

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

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

Australian Government Department of Human Services

This information was printed Sunday 4 December 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

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

On the surface, it looks like every healthcare special interest and their 1,400 lobbyists won an early Christmas present courtesy of the 21st Century Cures Act, which passed the House of Representatives by a whopping 392-26 margin last week and appears headed for Senate passage and enactment.
Source: modernhealthcare.com

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

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 Enrollment Archives

Posted by:  :  Category: Medicare

There are numerous Medicare election periods, each of them serving a different purpose when it comes to signing up for benefits. This article illustrates the difference between the two periods that sound incredibly similar. The Initial Enrollment Period (IEP)… Read more
Source: medicare.com

National Provider Enrollment Workshop

I can’t imagine how difficult it would be to educate participants when they vary by provider type and level of experience/knowledge about provider enrollment; however, [the speakers] did an AMAZING job! While regulations, guidelines, and information are critical to what we do they can be less than exciting; yet, they maintained everyone’s attention, and even threw in some humor which was needed!
Source: decisionhealth.com

Medicare Rehab in New York

Posted by:  :  Category: Medicare

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Source: sober-solutions.com

EmblemHealth: Medicare Coverage

All Medicare Advantage Plans and Medicare Prescription Drug Plans agree to stay in the program for a full calendar year at a time. Each year, plans can decide whether to continue to participate with Medicare Advantage or Medicare Prescription Drug Plans. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan or Prescription Drug Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
Source: emblemhealth.com