Older Americans, Medicare, and the Affordable Care Act: What's Really In It for Elders?

Posted by:  :  Category: Medicare

Most of the enacted changes are targeted at the components of the plans themselves, but their overall effect reduces the profit potential of operating a Medicare Advantage plan. Thus, the ACA restructures payments to these plans and offers a range of bonuses to encourage quality enhancement. At the same time, the ACA mandates certain minimum levels of expenditures for patients’ medical care via stipulated “medical loss ratios.” Thus, the plans are limited in terms of what they pay for non-medical expenses, such as marketing, profits, salaries, administrative costs, and agent commissions (HHS, 2010). Because Medicare Advantage plans may not discontinue any “guaranteed Medicare benefits,” they are likely to scale back or eliminate many of the extra benefits they provide, such as vision and dental care. Some Medicare Advantage plans may raise premiums for their enrollees, while other plans may cease participating in the Medicare program.
Source: asaging.org

2017 MLC Preconference Seminars

Healthcare is undergoing a seismic change; hospice is right at the epicenter. But no one – except a wet baby – likes change. In this participatory seminar, we will demonstrate how every hospice clinical leader and hospice executive needs to ensure that hospice maintains its missional heart while, at the same time, changing and reinventing itself in response to a myriad of external and internal pressures. How? By developing transformational leaders. Learn the secret sauces of transformational leadership: storytelling, leading together and negotiation. Whether your hospice is large or small, for‐profit or non‐profit, rural or urban, this is a “must attend” session for every executive, leader and manager in hospice.
Source: nhpco.org

APPRISE Medicare Counseling

Remember that Medicare covers a number of preventive screening and tests to help you achieve that goal and live a healthy lifestyle. Preventive tests include the flu shot, colonoscopy, mammogram, prostate cancer screening, yearly wellness visit, bone mass measurement and screenings for depression, cardiovascular issues, diabetes, glaucoma, obesity, and STD. Self-management for diabetes training is available as well counseling for obesity. Don’t forget your pneumococcal shot. Make this your best year yet and take better care of yourself!
Source: rsvpmc.org

Application status lookup tool

Posted by:  :  Category: Medicare

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

How to complete the EDI enrollment form

The Electronic Data Interchange (EDI) enrollment form is an interactive form to be completed on-screen. After completion this form can be printed for signatures then faxing or mailed. This interactive for now allows an authorized electronic signature and can be emailed. Please see guidelines of authorized signature further in these instructions. This form is intended for provider use only and only the owner of the NPI/PTAN may inquire the status of the application.
Source: fcso.com

Beneficiary Eligibility Denials

Denial Reason, Reason/Remark Code(s) PR-26: Expenses incurred prior to coverage PR-27: Expenses incurred after coverage terminated Resolution/Resources: Verify patient eligibility prior to submitting claims to Medicare through the Palmetto GBA Online Provider Services (OPS) tool or Interactive Voice Response (IVR) unit. We have to check the eligibility information through the insurance website or by calling the payer. Once we got the information we have to check the billed Date Of Service, if it prior or after the coverage then we can very well go ahead and bill the patient without any hesitation. Online Eligibility Verification through eServices All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so. Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI. Online Eligibility Verification through OPS
Source: medicarepaymentandreimbursement.com

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

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.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

California and the ACA’s Medicaid expansion: eligibility, enrollment and benefits

Posted by:  :  Category: Medicare

Medicaid expansion has raised concerns about overburdening the health care system with a flood of new patients and challenging the financial viability of the program. An Oregon study released in early 2014 reinforced those fears. The study showed more use of primary care and about a 40 percent increase in emergency room visits among the newly insured. However, a recent study by the UCLA Center for Health Policy Research found that the spike in emergency room use was temporary — dropping by two-thirds after two years. The study also found that primary care use did not climb in response to the drop off of emergency room use — meaning overall utilization tapered off. Lead author Jerry Kominski summarized the study this way: “What our findings say to the country is (that) concerns about Medicaid expansion being financially unsustainable into the future are unfounded.”
Source: healthinsurance.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

Understanding Medicare Eligibility in California

Original Medicare includes Part A, which is hospital insurance that covers any inpatient stays in a hospital and Part B medical insurance that covers doctor’s visits and outpatient services. These are included in original Medicare, but many who are eligible for Medicare opt for Medicare Advantage to get the most out of Medicare eligibility. California Medicare Advantage plans often include Part D insurance as well, which is coverage for prescription drugs. Original Medicare does not include this coverage, although there are separate Part D drug plans available for purchase. There are a number of reasons that Medicare Advantage is often opted for with Medicare eligibility. California Medicare Advantage plans can include:
Source: healthmarkets.com

California Medicare Age Eligibility

Medicare Advantage plans can be purchased/selected in addition to Original Medicare (Parts A and B), and become primary to Original Medicare. Advantage plans are required to cover everything that Original Medicare covers, with the exception of hospice care, which is covered by Original Medicare even if you are in a Medicare Advantage Plan.
Source: camedicare.com

Medicare Advantage Plan: PPO Blue ValueRx

Posted by:  :  Category: Medicare

Medicare PPO Blue ValueRx 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 Medicare PPO and Blue Medicare HMO Providers

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

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

Medicare Supplement Plans

Posted by:  :  Category: Medicare

There are no fees associated with requesting Medicare Supplement Insurance comparisons, and you are under no obligation. If you have questions, and/or need advice you can contact one of our Licensed Medicare Supplement Insurance Specialists at 1-855-593-0069.
Source: directmedsup.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

Direct Graduate Medical Education (DGME)

Prior to July 1, 2010, under section 1886(h)(4)(E) of the Act, a hospital could count residents training in nonprovider settings for direct GME purposes (and under section 1886(d)(5)(B)(iv) of the Act, for IME purposes), if the residents spent their time in patient care activities and if “. . . the hospital incurs all, or substantially all, of the costs for the training program in that setting.” The implementing regulations, first at §413.86(f)(3), effective July 1, 1987, and later at §413.86(f)(4) (redesignated as §413.78(d)) , effective January 1, 1999, required that, in addition to incurring all or substantially all of the costs of the program at the nonprovider setting, there must have been a written agreement between the hospital and the nonprovider site (in place prior to the time the hospital began to count the residents training in the non-provider site) stating that the hospital would incur all or substantially all of the costs of training in the nonprovider setting. The regulations further specified that the written agreement must have indicated the amount of compensation provided by the hospital to the nonprovider site for supervisory teaching activities. Effective October 1, 2004, the hospital must have either had a written agreement with the nonprovider setting, or, as described in the regulations at §413.78(e), paid for all or substantially all of the costs, concurrent with the training in the nonprovider setting. Effective for cost reporting periods beginning on or after July 1, 2007 and before July 1, 2010, “all or substantially all of the costs for the training program” in the nonprovider setting is defined as at least 90 percent of the total of the costs of the residents’ salaries and fringe benefits (including travel and lodging where applicable) and the portion of the cost of teaching physician’s salaries attributable to nonpatient care direct GME activities.
Source: cms.gov

Direct Mail Leads for Medicare Supplement, Final Expense and More

Send a mailer to the names available on our accurate and qualified lists using our turn key lead services. Names to mail with age and income selection, forms, printing, bulk rate outgoing shipping, response postage and handling, scanning, uploading and data entry into TLLM are all included in the price you are given. If you would like to select additional demographics or duplicate lists we can add those options to your order. All leads returned are EXCLUSIVE to you and your order. The households (not just the names) you mail are also protected for at least 90 days giving you plenty of time to receive and work your leads.
Source: targetleads.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

Medicare Health Benefits MHB Insurance Services

Posted by:  :  Category: Medicare

We work as facilitators, listening to the voices of many, both prominent and under served. Ultimately our decisions are made possible by considering ideas brought to light by those voices. We provide the opportunity for people to prosper and connect within their communities.
Source: medicarehealthbenefits.com

Learn What to do If you Already Have Medicare Health Coverage

Yes. Coverage from an employer through the SHOP Marketplace is treated the same as coverage from any job-based health plan. If you’re getting health coverage from an employer through the SHOP Marketplace based on your or your spouse’s current job, Medicare Secondary Payer rules apply.
Source: healthcare.gov

Medicare and PEBB Program benefits

Note: You may choose to purchase a Medicare Advantage plan from a private insurance company or enroll in one of the PEBB plans, if eligible for PEBB retiree coverage. PEBB offers Medicare Advantage plans with Kaiser Permanente WA (formerly Group Health) and Kaiser Permanente NW (Kaiser Senior Advantage). If you do not live in an area that offers the Advantage plan, Kaiser Permanente WA and Kaiser Permanente NW will enroll you in the Medicare coordination of benefits (COB) plans. Uniform Medical Plan (UMP) offers a Medicare COB plan. If you choose to enroll in Medicare Advantage with a private insurance company, you forfeit your right to enroll in PEBB retiree insurance.
Source: wa.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

Medicare Coverage Guidelines

*By clicking this button I hereby authorize Hoveround to call me on the residential or wireless telephone number I provided above. I understand and agree to be called with information on Hoveround’s products and services, and that automated telephone technology may be used including autodialing and/or prerecorded calls to contact me. I understand that consent is not a condition of purchase. Certain restrictions apply. Not available in all locations. Call for details.
Source: hoveround.com

Medicare Information and Plan Comparisons

Posted by:  :  Category: Medicare

While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Source: medicare.org

Medicare Supplement Plans

There are no fees associated with requesting Medicare Supplement Insurance comparisons, and you are under no obligation. If you have questions, and/or need advice you can contact one of our Licensed Medicare Supplement Insurance Specialists at 1-855-593-0069.
Source: directmedsup.com

Kansas Insurance Department

Follow These Simple Instructions: Complete the following information and click “Submit.” You will then receive a list of estimated yearly premiums customized to your demographic information. You may click on the company name to receive other important aspects of the policy.
Source: ksinsurance.org

Medicare Supplement Plan F

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. **This high deductible plan pays the same or offers the same benefits as Plan F after you have paid a calendar year $2110 deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $2110. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.
Source: medigap360.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

Fidelis Care Health Insurance

Posted by:  :  Category: Medicare

Fidelis offers health plans for individuals, Medicare eligible beneficiaries and Medicaid eligible people. They provide free or low-cost health insurance through a variety of health programs that help cover preventive care, prenatal care, labs and immunizations, emergency care, and more.
Source: healthplanone.com

Leaps & Bounds Occupational Therapy of Elmira Heights, NY

Leaps and Bounds Occupational Therapy, PLLC is an occupational therapy private practice servicing the Elmira Heights, Elmira, Corning, Horseheads NY and PA regions in the Finger Lakes Southern Tier of New York State. See how our occupational therapy services can help you and your family. We are now in-network with NYS Medicaid, Tricare, Fidelis, Blue Cross Blue Shield, and United HealthCare, United HealthCare Community Plan, NYS Empire, and Medicare! Please browse our website and see what we can offer, contact our office with any questions!
Source: leapsboundsot.com

Audit: Medicare wastes billions on defective medical devices

“Collecting the DI is complex and involves providers changing their workflow and billing systems as well as requiring public and private payers … and other entities to change their claims processing systems,” the officials said in a July 13 letter. “CMS also needs to modify numerous legacy computer systems to collect DIs for implantable devices on Medicare claims, which would require additional funding and resources.”
Source: startribune.com