Tuesday, May 6th, 2008

Health insurer WellPoint Inc. announced Monday May 5, 2008 that its National Government Services subsidiary was selected by the Centers for Medicare & Medicaid Services to administer the Medicare Administrative Contract for an area that includes New York and Connecticut.

Under the new contract, the WellPoint unit will perform key administrative functions for Medicare’s contracts with hospitals, skilled nursing complexes and physicians. They will manage all appeals, audit and reimbursement, claims processing, medical review and coverage determinations.

Monday, May 5th, 2008

Mercury News.com reported today that a coalition of health care groups have filed a lawsuit against the state of California to prevent 10 percent cuts to Medi-Cal and Denti-Cal payments scheduled to begin July 1, 2008. There are more than 6 million low-income Californians that use Medi-Cal for health care services. The class-action lawsuit has been filed in The Los Angeles Superior Court on behalf of California health care providers. The complaint includes the California Medical Association, the California Hospital Association and the California Dental Association.

Monday, April 28th, 2008

Medicare health insurer, Humana Inc. reported a 12.5 percent rise in its first-quarter profit. The growth in its Medicare Advantage and commercial businesses more than offset an expected decline in its stand-alone Medicare prescription drug plans.The results beat Wall Street expectations, and the company raised full-year earnings-per-share projections.

The Louisville-based company earned $80.17 million, or 47 cents per share, in the three months ended March 31 compared to $71.2 million, or 42 cents a share, in the year-ago period.Revenue rose 12 percent to $6.96 billion from $6.2 billion.

The Medicare Advantage plans offer comprehensive health coverage.

Saturday, March 29th, 2008

Yesterday,The federal government’s top official for Medicare and Medicaid administration encouraged area medical providers to participate in a federal program that will pay providers to adopt electronic medical records.

Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, spoke to area doctors and medical administrators about the pilot program.

During a five-year period, the government will give financial incentives ranging from $58,000 per doctor to $290,000 per practice to adopt government-certified medical records software.
Medical practices will compete for the money through a proposals process, and 12 communities will be chosen for the demonstration project.

“We are looking for communities like Sioux Falls that have a strong base of primary care physicians and are willing to assist us in educating and recruiting local physician practices for the demonstration,” Weems said.

President Bush has set a goal to have most Americans have access to a secure and interoperable electronic health record by 2014. The government contends electronic medical records will reduce costs and increase quality of care.

Friday, March 14th, 2008

The Assisted Living Federation of America (ALFA) has set an initiative to eliminate the prescription drug expense paid by poor seniors who live in assisted living communities.

Reps. Lloyd Doggett (D-25th TX) and Lincoln Diaz-Balart (R-21st FL) and twelve other House members are sponsoring HR 5604, the Medicare Part D Home and Community Services Copayment Equity Act of 2008. This bipartisan measure corrects an apparent oversight in the Medicare Part D Prescription Drug Program by exempting drug co-payments for residents in assisted living and other home and community-based settings who qualify for both Medicare and Medicaid. The measure treats these so-called dual-eligible recipients the same as Medicaid recipients in nursing homes.The legislation will provide financial relief to one million seniors, including 125,000 residents of assisted living communities, and cost an estimated $171 million annually.

Prescription drug co-payments can range from $1 to $5 for each prescription.A typical assisted living resident takes between eight and 10 different prescription drugs per month, the same as residents of nursing homes. This legal oversight created hardship for Medicaid recipients whose personal needs allowance is limited to about $55 per month for items, such as clothing, shoes and personal hygiene items. Assisted living providers have been using their own funds to subsidize these affected residents for more than two years.

Source: www.earthtimes.com

Thursday, February 28th, 2008

The Medicare Funding Warning Response Act of 2008 would require HHS to develop a plan to ensure that at least 50 percent of the care provided by Medicare would be covered by value-based or pay-for-performance measures by the year 2013. That move could saddle family physicians with much of the cost of meeting the requirement because many of the performance measures apply to primary care, said Kevin Burke, director of the AAFP’s Division of Government Relations.

Under the Medicare Funding Warning Response Act of 2008, the federal government could also withhold a portion of payments to physicians based on their ability to meet quality and efficiency standards, forcing them to compete for limited payments, Burke said. Certain quality-related provisions, such as those dealing with electronic health records, pricing transparency and value-based purchasing, would not be implemented unless they saved money.

Source: www.aafp.com

Friday, February 1st, 2008

HealthDay News reported Thursday that the three-year-old Medicare Part D drug program is seeing the number of its enrollees climb, even as costs for the program fall.

The overall costs for Medicare Part D beneficiaries and taxpayers are lower than originally projected. The enrollments continue to rise and customer satisfaction remains very high. Many are still not excited, with many still faulting the program for its complexity, its high co-pays on some drugs and its inability to negotiate lower prices with the drug industry.According to article, the projected cost for Medicare part D is $117 billion lower over the next decade than experts estimated just last summer. At the same time, after the third open enrollment period that ended in December, the plan now has an additional 1.5 million people.Overall, there are about 25.4 million people enrolled in Part D. There are now 39.5 million people, most in Medicare, with some form of drug coverage.Drugcovergae is very important for individuals to think about. It could help lower monthly costs of precriptions dramatically.

Thursday, January 24th, 2008

Long-term care is defined as a variety of services that include medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health care or personal needs. Most of the time long-term care is to assist people with support services such as activities of daily living like bathing, dressing and using the bathroom. Long-term care can be provided in the home, in a community, in a assisted living community or in a nursing home.

By 2020, 12 million older Americans will need long-term care. Most will be cared for at home. Family and friends make up 70 percent ofthe solecargiversfor those individuals. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home will stay there five years or more.

Source. www.medicare.gov

Friday, December 21st, 2007

Medicare is a Health Insurance Program for:

• People 65 years of age and older.
• Some people with disabilities under age 65.
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has Two Parts:

• Part A (Hospital Insurance) Most people don’t have to pay for Part A.
• Part B (Medical Insurance) Most people pay monthly for Part B.

Medicare offers you the ability to choose different services. Depending on where you live, you could have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan after that you may want to consider a Medicare Prescription Drug Plan to add drug coverage to your health plan. You may also want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.

As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have the Original Medicare Plan, or you belong to a Medicare Advantage Plan (like an HMO or PPO). For more information see the Your Medicare Coverage database.