Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
The compulsory portion of Medicare that is known as the Hospital Insurance Program. All persons 65 years and older who are entitled to benefits under the Old Age, Survivors, Disability and Health Insurance Program or railroad retirement, persons under the age of 65 who have been eligible for disability for more than two years, and insured workers (and their dependents) requiring renal dialysis or kidney transplantation are automatically enrolled in Medicare Part A.
Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)
Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.
Processes or methods of reimbursement for services rendered or equipment.
Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.
A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
The Commission was created by the Balanced Budget Act of 1997 under Title XVIII. It is specifically charged to review the effect of Medicare+Choice under Medicare Part C and to review payment policies under Parts A and B. It is also generally charged to evaluate the effect of prospective payment policies and their impact on health care delivery in the US. The former Prospective Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC) were merged to form MEDPAC.
A supplemental health insurance policy sold by private insurance companies and designed to pay for health care costs and services that are not paid for either by Medicare alone or by a combination of Medicare and existing private health insurance benefits. (From Facts on File Dictionary of Health Care Management, 1988)
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
A listing of established professional service charges, for specified dental and medical procedures.
A method of examining and setting levels of payments.
Criteria to determine eligibility of patients for medical care programs and services.
Economic aspects related to the management and operation of a hospital.
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.
Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.
An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
Pricing statements presented by more than one party for the purpose of securing a contract.
Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.
The design, completion, and filing of forms with the insurer.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.
Coded listings of physician or other professional services using units that indicate the relative value of the various services they perform. They take into account time, skill, and overhead cost required for each service, but generally do not consider the relative cost-effectiveness. Appropriate conversion factors can be used to translate the abstract units of the relative value scales into dollar fees for each service based on work expended, practice costs, and training costs.
The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.
The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
Facilities designed to serve patients who require surgical treatment exceeding the capabilities of usual physician's office yet not of such proportion as to require hospitalization.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)
Amounts charged to the patient as payer for medical services.
Outside services provided to an institution under a formal financial agreement.
Application of marketing principles and techniques to maximize the use of health care resources.
Institutions with an organized medical staff which provide medical care to patients.
Descriptive terms and identifying codes for reporting medical services and procedures performed by PHYSICIANS. It is produced by the AMERICAN MEDICAL ASSOCIATION and used in insurance claim reporting for MEDICARE; MEDICAID; and private health insurance programs (From CPT 2002).
A cancer registry mandated under the National Cancer Act of 1971 to operate and maintain a population-based cancer reporting system, reporting periodically estimates of cancer incidence and mortality in the United States. The Surveillance, Epidemiology, and End Results (SEER) Program is a continuing project of the National Cancer Institute of the National Institutes of Health. Among its goals, in addition to assembling and reporting cancer statistics, are the monitoring of annual cancer incident trends and the promoting of studies designed to identify factors amenable to cancer control interventions. (From National Cancer Institute, NIH Publication No. 91-3074, October 1990)
Amounts charged to the patient as payer for health care services.
Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.
The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.
The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
The confinement of a patient in a hospital.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Directions written for the obtaining and use of DRUGS.
The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).
Laws concerned with manufacturing, dispensing, and marketing of drugs.
Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
The obtaining and management of funds for hospital needs and responsibility for fiscal affairs.
Subsequent admissions of a patient to a hospital or other health care institution for treatment.
Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.
An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.
Drugs that cannot be sold legally without a prescription.
Process of shifting publicly controlled services and/or facilities to the private sector.
Economic sector concerned with the provision, distribution, and consumption of health care services and related products.
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.
Medical and skilled nursing services provided to patients who are not in an acute phase of an illness but who require a level of care higher than that provided in a long-term care setting. (JCAHO, Lexikon, 1994)
Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
Organizations of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. Assigned means those beneficiaries for whom the professionals in the organization provide the bulk of primary care services. (www.cms.gov/OfficeofLegislation/Downloads/Accountable CareOrganization.pdf accessed 03/16/2011)
Cost-sharing mechanisms that provide for payment by the insured of some portion of covered expenses. Deductibles are the amounts paid by the insured under a health insurance contract before benefits become payable; coinsurance is the provision under which the insured pays part of the medical bill, usually according to a fixed percentage, when benefits become payable.
A cabinet department in the Executive Branch of the United States Government concerned with overall planning, promoting, and administering programs pertaining to VETERANS. It was established March 15, 1989 as a Cabinet-level position.
The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.
Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.
Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.
A nursing specialty involved in the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems with the characteristics of altered functional ability and altered life-style.
Hospitals located in a rural area.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.
In health care reimbursement, especially in the prospective payment system, those patients who require an unusually long hospital stay or whose stay generates unusually high costs.
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
Activities concerned with governmental policies, functions, etc.
Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
Advanced technology that is costly, requires highly skilled personnel, and is unique in its particular application. Includes innovative, specialized medical/surgical procedures as well as advanced diagnostic and therapeutic equipment.
Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.
The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)
Services for the diagnosis and treatment of disease and the maintenance of health.
Public or private organizations that provide, either directly or through arrangements with other organizations, home health services in the patient's home. (Hospital Administration Terminology, 2d ed)
Government sponsored social insurance programs.
Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.
Differences in access to or availability of medical facilities and services.
Procedures used by chiropractors to treat neuromusculoskeletal complaints.
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
Short-term debt obligations and assets occurring in the regular course of operational transactions.
Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings.
Organizations representing designated geographic areas which have contracts under the PRO program to review the medical necessity, appropriateness, quality, and cost-effectiveness of care received by Medicare beneficiaries. Peer Review Improvement Act, PL 97-248, 1982.
Purchasers are provided information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. The focus is on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. (from http://www.ahrq.gov/qual/meyerrpt.htm accessed 11/25/2011)
The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.
The period of confinement of a patient to a hospital or other health facility.
The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
Customer satisfaction or dissatisfaction with a benefit or service received.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
Revenues or receipts accruing from business enterprise, labor, or invested capital.
Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.
Health care provided to individuals.
Hospitals owned and operated by a corporation or an individual that operate on a for-profit basis, also referred to as investor-owned hospitals.
Prepaid health and hospital insurance plan.
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
Individuals whose ancestral origins are in the continent of Europe.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
Federal, state, or local government organized methods of financial assistance.
Florida is a state in the southeastern United States known for its warm climate, tourist attractions, and as a popular destination for retirement and healthcare.
Hospitals providing medical care to veterans of wars.
PL97-248. Title II of the Act specifies "provisions relating to savings in health and income security programs." This includes changes in payment for services, benefits and premiums of Medicare as well as changes in provisions under Medicaid and other specific programs covered by Social Security. Title II includes various revenue measures.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (1/2846)

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.  (+info)

Organizational and environmental factors associated with nursing home participation in managed care. (2/2846)

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.  (+info)

Use of out-of-plan services by Medicare members of HIP. (3/2846)

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.  (+info)

The changing elderly population and future health care needs. (4/2846)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Hospitals and managed care: catching up with the networks. (5/2846)

Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies.  (+info)

Differences in physician compensation for cardiovascular services by age, sex, and race. (6/2846)

The purpose was to determine whether physicians receive substantially less compensation from patient groups (women, older patients, and nonwhite patients) that are reported to have low rates of utilization of cardiovascular services. Over an 18-month period we collected information on payments to physicians by 3,194 consecutive patients who underwent stress testing an 833 consecutive patients who underwent percutaneous coronary angioplasty at the Yale University Cardiology Practice. Although the charges for procedures were not related to patient characteristics, there were large and significant differences in payment to physicians based on age, sex, and race. For example, physicians who performed percutaneous transluminal coronary angioplasty received at least $2,500 from, or on behalf of, 72% of the patients 40 to 64 years old, 22% of the patients 65 to 74 years old, and 3% of the patients 75 years and older (P < 0.001); from 49% of the men and 28% of the women (P < 0.001); and 42% of the whites and 31% of the nonwhites (P < 0.001). Similar differences were observed for stress testing. These associations were largely explained by differences in insurance status.  (+info)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (7/2846)

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.  (+info)

Medicare HMOs: who joins and who leaves? (8/2846)

Medicare risk health maintenance organizations (HMOs) are an increasingly common alternative to fee-for-service Medicare. To date, there has been no examination of whether the HMO program is preferentially used by blacks or by persons living in lower-income areas or whether race and income are associated with reversing Medicare HMO selection. This question is important because evidence suggests that these beneficiaries receive poorer care under the fee-for-service-system than do whites and persons from wealthier areas. Medicare enrollment data from South Florida were examined for 1990 to 1993. Four overlapping groups of enrollees were examined: all age-eligible (age 65 and over) beneficiaries in 1990; all age-eligible beneficiaries in 1993; all age-eligible beneficiaries residing in South Florida during the period 1990 to 1993; and all beneficiaries who became age-eligible for Medicare benefits between 1990 and 1993. The associations between race or income and choice of Medicare option were examined by logistic regression. The association between the demographic characteristics and time staying with a particular option was examined with Kaplan-Meier methods and Cox Proportional Hazards modeling. Enrollment in Medicare risk HMOs steadily increased over the 4-year study period. In the overall Medicare population, the following statistically significant patterns of enrollment in Medicare HMOs were seen: enrollment of blacks was two times higher than that of non-blacks; enrollment decreased with age; and enrollment decreased as income level increased. For the newly eligible population, initial selection of Medicare option was strongly linked to income; race effects were weak but statistically significant. The data for disenrollment from an HMO revealed a similar demographic pattern. At 6 months, higher percentages of blacks, older beneficiaries (older than 85), and individuals from the lowest income area (less than $15,000 per year) had disenrolled. A small percentage of beneficiaries moved between HMOs and FFS plans multiple times. These data on Medicare HMO populations in South Florida, an area with a high concentration of elderly individuals and with one of the highest HMO enrollment rates in the country, indicate that enrollment into and disenrollment from Medicare risk HMOs are associated with certain demographic characteristics, specifically, black race or residence in a low-income area.  (+info)

In the medical field, cost sharing refers to the way in which the costs of healthcare services are shared between the patient and the healthcare provider. Cost sharing can take many forms, including copayments, coinsurance, and deductibles. A copayment is a fixed amount of money that the patient is required to pay for a specific healthcare service, such as a doctor's visit or a prescription medication. Coinsurance is a percentage of the total cost of a healthcare service that the patient is responsible for paying. For example, if a healthcare service costs $100 and the patient's coinsurance is 20%, the patient would be responsible for paying $20. A deductible is the amount of money that the patient must pay out of pocket before their insurance coverage kicks in. For example, if a patient's deductible is $1,000, they would be responsible for paying the first $1,000 of their healthcare expenses before their insurance begins to cover the costs. Cost sharing is often used as a way to control healthcare costs and encourage patients to be more mindful of their healthcare spending. However, it can also make healthcare more expensive for patients, particularly those with high deductibles or those who require expensive medical treatments.

In the medical field, competitive bidding refers to a procurement process in which healthcare providers or organizations submit bids to offer the lowest prices for medical equipment, supplies, or services. The purpose of competitive bidding is to reduce costs and improve efficiency in the procurement process. In competitive bidding, healthcare providers or organizations submit sealed bids for a specific product or service, and the bid with the lowest price is selected. The winning bidder is then awarded the contract to provide the product or service to the healthcare provider or organization. Competitive bidding is often used by government agencies, such as Medicare and Medicaid, to purchase medical equipment and supplies for use in hospitals, clinics, and other healthcare facilities. The use of competitive bidding can help to reduce costs and ensure that healthcare providers have access to high-quality medical equipment and supplies at affordable prices.

In the medical field, a capitation fee is a fixed amount of money paid to a healthcare provider, such as a doctor or a hospital, for each patient they agree to treat over a certain period of time, typically a year. The fee is usually based on the number of patients enrolled in the provider's care and is intended to cover the provider's costs of providing care, including administrative expenses, salaries, and other overhead costs. Capitation fees are often used in managed care plans, such as health maintenance organizations (HMOs), to help control healthcare costs by providing a fixed payment for each patient, rather than paying for each service or procedure provided. The provider is then responsible for managing the patient's care and ensuring that the patient receives appropriate and necessary medical services within the scope of the capitation fee. Capitation fees can be controversial because they may incentivize providers to limit the amount of care they provide to patients in order to save money, which could potentially harm the patients' health. However, proponents argue that capitation fees can help to control healthcare costs and improve the quality of care by encouraging providers to focus on preventive care and managing chronic conditions.

In the medical field, cost savings refer to the reduction in expenses or costs associated with providing healthcare services. This can include reducing the cost of medical procedures, medications, and equipment, as well as reducing the length of hospital stays and the number of readmissions. Cost savings can be achieved through a variety of strategies, such as implementing more efficient processes and workflows, using technology to automate tasks, and negotiating lower prices with suppliers and vendors. Additionally, cost savings can be achieved by promoting preventive care and early intervention, which can reduce the need for more expensive treatments later on. Overall, the goal of cost savings in the medical field is to provide high-quality care while minimizing expenses and reducing the financial burden on patients, healthcare providers, and insurance companies.

In the medical field, cost allocation refers to the process of assigning costs to specific services or departments within a healthcare organization. This process is used to determine how much of the organization's overall expenses should be attributed to each department or service, so that they can be accurately billed to patients or insurance companies. Cost allocation is important in the medical field because it helps healthcare organizations to manage their finances more effectively. By accurately tracking and allocating costs, organizations can identify areas where expenses are high and take steps to reduce them. This can help to improve the overall efficiency and profitability of the organization. There are several methods that can be used to allocate costs in the medical field, including the direct method, the indirect method, and the step-down method. The choice of method will depend on the specific needs and circumstances of the organization.

In the medical field, cost control refers to the process of managing and reducing the expenses associated with healthcare services and treatments. This involves identifying areas where costs can be reduced without compromising the quality of care provided to patients. Cost control in healthcare can be achieved through various strategies, such as implementing evidence-based practices, reducing waste and inefficiencies, negotiating with suppliers and vendors, and optimizing resource utilization. For example, healthcare providers may use electronic health records (EHRs) to streamline administrative tasks and reduce paperwork, or they may use telemedicine to provide remote consultations and reduce the need for in-person visits. Effective cost control in healthcare is important for ensuring that patients receive affordable and accessible care, while also ensuring that healthcare providers can operate sustainably and remain financially viable.

In the medical field, a budget is a financial plan that outlines the projected income and expenses for a specific period of time, such as a year or a quarter. Medical budgets are used to manage the financial resources of healthcare organizations, including hospitals, clinics, and other healthcare facilities. Medical budgets typically include expenses related to personnel, supplies, equipment, rent or lease payments, utilities, and other operational costs. They may also include revenue projections, such as patient charges, insurance reimbursements, and other sources of income. Effective budgeting in the medical field is critical for ensuring that healthcare organizations are able to provide high-quality care while remaining financially sustainable. By carefully tracking and managing their finances, healthcare organizations can make informed decisions about how to allocate resources, invest in new technologies and equipment, and respond to changes in the healthcare landscape.

In the medical field, Contract Services refer to agreements between healthcare providers and third-party companies or organizations to provide specific services or support. These services can include a wide range of activities such as medical billing, transcription, coding, and consulting services. Contract Services can be beneficial for healthcare providers as they can help to reduce costs, improve efficiency, and allow them to focus on their core clinical responsibilities. For example, a healthcare provider may enter into a contract with a medical billing company to handle the administrative tasks associated with billing and insurance claims, freeing up the provider's time to focus on patient care. Contract Services can also be beneficial for third-party companies or organizations as they can provide a steady stream of revenue and allow them to specialize in specific areas of healthcare. For example, a medical transcription company may specialize in transcribing medical records for healthcare providers, allowing them to provide high-quality services to a large number of clients. Overall, Contract Services play an important role in the medical field by providing healthcare providers with the support they need to operate efficiently and effectively, while also providing third-party companies or organizations with a valuable source of revenue.

Current Procedural Terminology (CPT) is a standardized coding system used in the medical field to identify and report medical, surgical, and diagnostic procedures performed by healthcare providers. It is maintained by the American Medical Association (AMA) and is widely used by healthcare providers, payers, and clearinghouses in the United States to process and reimburse claims for medical services. CPT codes are composed of five digits and are organized into categories based on the type of procedure being performed. The first digit identifies the category, the second and third digits identify the specific procedure, and the fourth and fifth digits may be used to identify additional information about the procedure, such as the location where it was performed or the type of anesthesia used. CPT codes are used to accurately and consistently report medical procedures to insurance companies and other payers, which helps to ensure that healthcare providers are properly reimbursed for the services they provide. It is important for healthcare providers to accurately code their procedures using CPT codes to avoid denied claims and to receive timely payment for their services.

In the medical field, costs and cost analysis refer to the process of determining the expenses associated with providing healthcare services. This includes the costs of medical equipment, supplies, personnel, facilities, and other resources required to provide medical care. Cost analysis involves examining the costs associated with different aspects of healthcare delivery, such as patient care, administrative tasks, and research and development. This information can be used to identify areas where costs can be reduced or optimized, and to make informed decisions about resource allocation and pricing. Cost analysis is important in the medical field because it helps healthcare providers and administrators to understand the financial implications of providing care, and to make decisions that are both effective and efficient. By analyzing costs, healthcare providers can identify opportunities to improve the quality of care while reducing expenses, which can ultimately benefit patients and the healthcare system as a whole.

Accountable Care Organizations (ACOs) are a type of healthcare organization that is responsible for the quality and cost of care provided to a group of patients. ACOs are typically made up of a network of healthcare providers, such as hospitals, clinics, and physicians, who work together to coordinate care for their patients. The goal of ACOs is to improve the quality of care while reducing the overall cost of healthcare. To achieve this, ACOs use data and analytics to identify patients who are at risk of developing certain conditions or who are using a lot of healthcare resources. They then work with these patients to develop personalized care plans that address their specific needs and help them avoid unnecessary healthcare services. ACOs are typically paid a fixed amount of money per patient, rather than being reimbursed for each individual service they provide. This incentivizes them to focus on improving the overall health and well-being of their patients, rather than just treating individual conditions. Overall, ACOs are an important part of the healthcare system in the United States, as they are helping to improve the quality and efficiency of care while reducing costs for patients and healthcare providers alike.

Deductibles and coinsurance are two common features of health insurance plans that can affect the amount of money a policyholder is responsible for paying out-of-pocket for medical expenses. A deductible is the amount of money that a policyholder must pay for covered medical expenses before their insurance plan begins to pay for them. For example, if a policyholder has a $1,000 deductible, they must pay the first $1,000 of their covered medical expenses before their insurance plan begins to pay for the remaining expenses. Coinsurance, on the other hand, is a percentage of the total cost of covered medical expenses that a policyholder is responsible for paying after they have met their deductible. For example, if a policyholder has a 20% coinsurance rate and a $1,000 deductible, they would be responsible for paying 20% of the cost of any covered medical expenses that exceed $1,000. Together, deductibles and coinsurance can affect the overall cost of healthcare for policyholders. By setting a high deductible and coinsurance rate, insurance companies can keep premiums lower for policyholders, but it can also mean that policyholders may have to pay more out-of-pocket for medical expenses.

Cohort studies are a type of observational study in the medical field that involves following a group of individuals (a cohort) over time to identify the incidence of a particular disease or health outcome. The individuals in the cohort are typically selected based on a common characteristic, such as age, gender, or exposure to a particular risk factor. During the study, researchers collect data on the health and lifestyle of the cohort members, and then compare the incidence of the disease or health outcome between different subgroups within the cohort. This can help researchers identify risk factors or protective factors associated with the disease or outcome. Cohort studies are useful for studying the long-term effects of exposure to a particular risk factor, such as smoking or air pollution, on the development of a disease. They can also be used to evaluate the effectiveness of interventions or treatments for a particular disease. One of the main advantages of cohort studies is that they can provide strong evidence of causality, as the exposure and outcome are measured over a long period of time and in the same group of individuals. However, they can be expensive and time-consuming to conduct, and may be subject to biases if the cohort is not representative of the general population.

Ambulatory care refers to medical care that is provided to patients who do not require hospitalization. This type of care is typically provided in outpatient clinics, physician offices, urgent care centers, and other settings where patients can receive treatment and be discharged the same day. Ambulatory care can include a wide range of medical services, such as routine check-ups, diagnostic testing, vaccinations, wound care, physical therapy, and chronic disease management. It can also include procedures that do not require hospitalization, such as colonoscopies, endoscopies, and minor surgeries. The goal of ambulatory care is to provide high-quality medical care to patients in a convenient and efficient manner, while minimizing the need for hospitalization and reducing healthcare costs. It is an important component of the healthcare system, as it allows patients to receive medical care when they need it, without having to spend extended periods of time in a hospital setting.

In the medical field, data collection refers to the process of gathering and organizing information about patients, their health conditions, and their medical treatments. This information is typically collected through various methods, such as medical history interviews, physical exams, diagnostic tests, and medical records. The purpose of data collection in medicine is to provide a comprehensive understanding of a patient's health status and to inform medical decision-making. This information can be used to diagnose and treat medical conditions, monitor the effectiveness of treatments, and identify potential health risks. Data collection in medicine is typically carried out by healthcare professionals, such as doctors, nurses, and medical researchers. The data collected may include demographic information, medical history, physical examination findings, laboratory test results, and imaging studies. This information is often stored in electronic health records (EHRs) for easy access and analysis. Overall, data collection is a critical component of medical practice, as it enables healthcare professionals to provide personalized and effective care to their patients.

In the medical field, "age factors" refer to the effects of aging on the body and its various systems. As people age, their bodies undergo a variety of changes that can impact their health and well-being. These changes can include: 1. Decreased immune function: As people age, their immune system becomes less effective at fighting off infections and diseases. 2. Changes in metabolism: Aging can cause changes in the way the body processes food and uses energy, which can lead to weight gain, insulin resistance, and other metabolic disorders. 3. Cardiovascular changes: Aging can lead to changes in the heart and blood vessels, including increased risk of heart disease, stroke, and high blood pressure. 4. Cognitive changes: Aging can affect memory, attention, and other cognitive functions, which can lead to conditions such as dementia and Alzheimer's disease. 5. Joint and bone changes: Aging can cause changes in the joints and bones, including decreased bone density and increased risk of osteoporosis and arthritis. 6. Skin changes: Aging can cause changes in the skin, including wrinkles, age spots, and decreased elasticity. 7. Hormonal changes: Aging can cause changes in hormone levels, including decreased estrogen in women and decreased testosterone in men, which can lead to a variety of health issues. Overall, age factors play a significant role in the development of many health conditions and can impact a person's quality of life. It is important for individuals to be aware of these changes and to take steps to maintain their health and well-being as they age.

In the medical field, Accounts Payable and Receivable refer to the financial transactions related to the payment of bills and the collection of payments from patients or insurance companies. Accounts Payable refers to the amount of money a medical practice owes to its suppliers, vendors, and other creditors for goods and services received. This includes expenses such as medical supplies, equipment, and services provided by other healthcare providers. Accounts Receivable, on the other hand, refers to the amount of money owed to a medical practice by its patients or insurance companies for medical services rendered. This includes amounts due for patient visits, procedures, and other medical services provided. Managing Accounts Payable and Receivable is crucial for the financial health of a medical practice. Proper management of these accounts can help ensure that the practice has enough cash flow to cover its expenses and invest in growth opportunities.

Comorbidity refers to the presence of two or more medical conditions in the same individual at the same time. These conditions can be related or unrelated to each other, and they can affect the severity and treatment of each other. Comorbidity is common in many medical conditions, and it can complicate the diagnosis and management of the underlying condition. For example, a patient with diabetes may also have high blood pressure, which is a common comorbidity. The presence of comorbidity can affect the patient's prognosis, treatment options, and overall quality of life.

Consumer satisfaction in the medical field refers to the level of satisfaction that patients feel with the healthcare services they receive. It encompasses a range of factors, including the quality of care, the accessibility of services, the friendliness and professionalism of healthcare providers, the comfort and cleanliness of the healthcare facility, and the overall experience of the patient. Consumer satisfaction is an important metric for healthcare providers and organizations, as it can impact patient loyalty, patient retention, and patient referrals. It can also influence the reputation of the healthcare provider and the organization, as well as their ability to attract new patients. To measure consumer satisfaction in the medical field, healthcare providers and organizations often use surveys and other forms of feedback to gather information from patients about their experiences. This information can then be used to identify areas for improvement and to make changes that can enhance the overall quality of care and the patient experience.

Blue Cross Blue Shield Insurance Plans are a type of health insurance coverage that is offered by the Blue Cross Blue Shield Association, which is a federation of 36 independent, locally operated Blue Cross and Blue Shield companies. These plans are designed to provide individuals and families with comprehensive health insurance coverage, including coverage for doctor visits, hospital stays, prescription drugs, and other medical expenses. Blue Cross Blue Shield Insurance Plans are available in all 50 states and are typically offered through employers, government programs, and direct to individuals. They are known for their wide network of healthcare providers and their ability to provide coverage for a wide range of medical services.

Cost-benefit analysis (CBA) is a method used to evaluate the economic feasibility of a medical intervention or treatment. It involves comparing the costs of a particular treatment or intervention with the benefits it provides to patients, taking into account both the direct and indirect costs and benefits. In the medical field, CBA is often used to determine the most cost-effective treatment for a particular condition or disease. It can help healthcare providers and policymakers make informed decisions about resource allocation and prioritize treatments based on their cost-effectiveness. CBA typically involves the following steps: 1. Identifying the medical intervention or treatment being evaluated. 2. Estimating the costs associated with the intervention, including direct costs such as medical supplies and personnel time, as well as indirect costs such as lost productivity and quality of life. 3. Estimating the benefits of the intervention, including improvements in health outcomes, reduced morbidity and mortality, and increased quality of life. 4. Comparing the costs and benefits of the intervention to determine its cost-effectiveness. 5. Using the results of the CBA to inform decision-making about resource allocation and treatment prioritization. Overall, CBA can be a useful tool for healthcare providers and policymakers to make informed decisions about medical interventions and treatments, taking into account both the costs and benefits of each option.

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"About Medicare Rights Center". Medicare Rights Center. Retrieved 2019-04-02. McReynolds, J.E. (1992-04-08). "Medicare ... The Medicare Rights Center is a nonprofit organization founded in June 1989 as the Medicare Beneficiaries Defense Fund (MBDF) ... The Medicare Rights Center also maintains an online reference and coursework tool called Medicare Interactive (MI). " ... "Medicare Interactive". Medicare Interactive. Retrieved 2019-04-02. Franklin, Mary Beth (12 April 2017). "Courses available to ...
The Better Medicare Alliance (BMA) is an American 501(c)(4) advocacy and research group that supports Medicare Advantage, a ... "Our Allies". Better Medicare Alliance. Herman, Bob (April 21, 2015). "Allyson Schwartz named CEO of Medicare Advantage lobbying ... "About". Better Medicare Alliance. Archived from the original on August 11, 2015. Retrieved August 5, 2015. Alonso-Zaldivar, ... In early 2015, the group strongly opposed the rate decrease proposed by the Centers for Medicare and Medicaid Services (CMS) ...
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Medicare Payment Advisory Commission. 2020. p. 155. Damico, Anthony (2020-10-29). "Medicare Part D: A First Look at Medicare ... Official Medicare publications at Medicare.gov, includes official publications about the Part D benefit. Medicare & You ... Medicare.gov, the official website for people with Medicare. Prescription Drug Coverage homepage at Medicare.gov, a central ... Medicare Payment Advisory Commission. 2020. p. 168. Report to the Congress: Medicare Payment Policy (PDF). Medicare Payment ...
"Senior Medicare Patrols Help to Stop Medicare Fraud - ExpertMedicare.com". Retrieved 2016-08-09. "Senior Medicare Patrol ... Medicare fraud Murrin, Suzanne. "Memorandum Report: 2019 Performance Data for the Senior Medicare Patrol Projects" (PDF). U.S. ... The Senior Medicare Patrols (SMP) are a group of volunteer organizations funded by the United States Department of Health and ... From the program's start in 1997 through December 2019, SMP projects and staff have recovered about $129 million in Medicare ...
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Healthcare in Canada Two-tier healthcare "Canadian Doctors for Medicare". Canadian Doctors for Medicare. Retrieved 2023-04-12. ... Canadian Doctors for Medicare is a Canadian non-profit advocacy organization that was founded in Toronto in 2006. The ... Canadian Doctors for Medicare is based in Toronto, Ontario. The organization's first director was Danielle Martin, as of 2023, ... Duffin, Jacalyn (20 February 2018). "Doctors as Stewards of medicare, or not: CAMSI, MRG, CDM, DRHC and the thin alphabet soup ...
The Medicare Sustainable Growth Rate (SGR) was a method used by the Centers for Medicare and Medicaid Services (CMS) in the ... Medicare physician payment reform "Obama signs 6-month fix for medicare reimbursements to doctors". Kaiser Health News. June 25 ... That bill was the Protecting Access to Medicare Act of 2014 (H.R. 4302; 113th Congress). The table on the left is a table of ... The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) changed the calculation from fiscal year (FY) ...
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clerk.house.gov/Votes/200723 v t e (Medicare and Medicaid (United States), United States proposed federal health legislation, ... In January 2007, the 110th United States House of Representatives approved H.R. 4, the Medicare Prescription Drug Price ... a provision that was part of the GOP-sponsored 2003 measure called the Medicare Prescription Drug, Improvement, and ... to negotiate with drug companies for lower prices for the 23 million senior citizens who have signed up for Medicare's ...
Allocate $300 million per year in Medicare funding to revise the Medicare payment system. Those payments would be based on ... of cancer patients who are beneficiaries of the Medicare program. This legislation for the Medicare Quality Cancer Care ... Establish a national Medicare demonstration project implemented by the Centers for Medicare & Medicaid Services (CMS) and is ... By the Medicare payment system, H.R. 2872 calls for national reporting of key metrics of evidence-based care, and also refines ...
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Medicare.gov - the official website for people with Medicare Medicare Modernization Act at Medicare.gov Prescription Drug ... Medicare Catastrophic Coverage Act of 1988, previous expansion, repealed 1989 Medicare dual eligible Medicare Part D Medicare ... including Medicare Advantage Plans Medicare Personal Plan Finder at Medicare.gov - more detailed information about Medicare ... as well as Medicare Advantage plans Official Medicare publications at Medicare.gov - includes official publications about ...
Medicare has four parts (A, B, C, and D). Read more. ... Medicare is the U.S. governments health insurance program for ... What Is Medicare? (Centers for Medicare & Medicaid Services) Also in Spanish * What Medicare Covers (Centers for Medicare & ... Medicare (Social Security Administration) - PDF Also in Spanish * Medicare and You (Centers for Medicare & Medicaid Services) ... Medicare.gov (Centers for Medicare & Medicaid Services) Also in Spanish * Medicare: Find and Compare Health Care Providers ( ...
Medicare at a Glance *. Medicare pays physicians about 80% of the "reasonable charge" for covered services. At the same time, ... Some Medicare Advantage plans do.. Medicare doesnt cover eye health (except for eye exams for diabetes patients), which is an ... The Medicare fee schedule is released each year. Physicians who accept Medicare can choose to be a "participating provider" by ... The Problem With Medicare Billing Because claims are processed by Medicare administrative contractors, it can take about a ...
Learn how the Medicare Diabetes Prevention Program can help you lower your risk of type 2 diabetes and build healthy habits ... Enrollment in Medicare Part B through original Medicare (fee-for-service) or a Medicare Advantage (MA) plan. ... Taking part in Medicare Diabetes Prevention Program (MDPP) can make all the difference, and with Medicare Part B, its free! ... Not Covered by Medicare?. You may be eligible to enroll in the National Diabetes Prevention Program lifestyle change program, ...
... medicare - Featured Topics from the National Center for Health Statistics ... Tags medicaid, medicare, public-use data, rdc, research data center, social security ... Tags CMS, confidentiality, medicare, Office of Analysis and Epidemiology, record linkage, SSA ...
Cost to Medicare of influenza vaccine delivery and savings to Medicare, based on severe and mild influenza seasons* -- Medicare ... Because some Medicare beneficiaries received influenza vaccines from sources not reimbursed by Medicare, annual surveys were ... an influenza vaccine benefit would generate savings for Medicare. Estimated net costs per year of life gained by a Medicare ... Cost To Medicare Of Influenza Vaccine Delivery And Savings. SUMMARY. Pneumonia and influenza (P&I) are the sixth leading cause ...
... the new Medicare prescription-drug program, Medicare Part D, went into effect this week. What do you think? ... Criticized as needlessly confusing, the new Medicare prescription-drug program, Medicare Part D, went into effect this week. ... The new Medicare plan is far too difficult to make sense of, which is why I have chosen to die earlier than I had initially ...
Centers for Medicare and Medicaid Services. In April 2020, CMS recommended that all nonessential planned surgeries and ... Guideline] Centers for Medicare & Medicaid Services (CMS) recommendations: re-opening facilities to provide non-emergent non- ... a recent history and physical examination within 30 days per Centers for Medicare and Medicaid Services (CMS) requirement is ... Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/files/document/covid-elective-surgery- ...
... when another entity has the responsibility for paying before Medicare. When Medicare began in 1966, it was the primary payer ... is the term generally used when the Medicare program does not have primary payment responsibility - that is, ... Medicare pays Primary, COBRA pays secondary. *Individual is disabled and covered by Medicare & COBRA:. Medicare pays Primary, ... Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare ...
This is the traditional fee-for-service plan provided by Medicare. Or, you can choose Medicare Advantage (also known as Part C ... Do you know that there are different ways you can get your Medicare health and prescription drug coverage? You can choose ... Q: What is Medicare Advantage?. A: Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare ... Q: What is Original Medicare ?. A: Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows ...
Medicare Part B and Part D may provide coverage for insulin, insulin pumps, and other diabetes supplies and preventive services ... Original Medicare, Medicare Advantage (Part C), Medicare Part D, and Medigap may provide coverage for diabetes supplies and ... Medicare Part B does not cover insulin unless a person is medically required to use an insulin pump. In this case, Medicare ... Medicare will generally cover FreeStyle Libre for qualifying Medicare enrollees as a means to help manage type 1 or type 2 ...
... www.kff.org/medicare/issue-brief/medicare-advantage-in-2008/ class=see-more light-beige no-float inline-readmore,More,/a,,/p ... more than one in five of the nations 44 million people on Medicare as of April 2008. That represents an increase of more than ... 800,000 beneficiaries in just four months, continuing a period of unprecedented growth for private plans in Medicare since 2003 ... Medicare Advantage plans enrolled a record 9.8 million beneficiaries, ...
Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through ... The Centers for Medicare & Medicaid Services (CMS) April 5 finalized its Policy and Technical Changes to the Medicare Advantage ... Medicare Advantage, Medicaid managed care plans to draw scrutiny from HHS watchdog ... A bipartisan group of 233 representatives and 61 senators called on the Centers for Medicare… ...
Its positive that Medicare scheduled a meeting so rapidly, and that the meetings focus will be restricting use to the proper ... This evaluation does not prevent Medicare patients from getting Provenge, and all but one of the 15 Medicare contractors that ... The Centers for Medicare and Medicaid Services have scheduled a meeting on November 17 to discuss the proper use of Dendreons ... This doesnt remove all or every worry about Dendreon shares or even about the Medicare decisions, but it is a step in the ...
... ( 2003-10-09 15:46) (Xinhua) Huang Shuixiang, a 73-year-old farmer in east China ... China offers medicare to 900 million farmers. ( 2003-10-09). +Bloom is off the rose in Chinas bridal chambers. ( 2003-10-09). ... Under this new medicare system, cooperative medical funds will be set up in rural areas with money from three parties: the ... "From this point of view, without a solution to farmers medicare problem, it is hardly possible to realize a relatively rich ...
The first panel of the figure shows that total Medicare spending per enrollee begins trending upward when a UCC enters a ... Instead, the researchers find that UCC entry increases Medicare costs by much more than the average per-beneficiary UCC costs. ... By the sixth year after entry, the increase in annual Medicare spending is $269 per beneficiary (a 2 percent increase relative ... Using a 20 percent random sample of elderly, fee-for-service Medicare enrollees between 2006 and 2016, the researchers compare ...
Learn what Medicare managed care plans cover, how much they cost, and if youre eligible. ... Medicare managed care plans take the place of original Medicare. ... Medicare Part A vs. Medicare Part B: Whats the Difference?. ... Medicare managed plans are an alternative to original Medicare (parts A and B). Sometimes referred to as Medicare Part C or ... Youll need to have your red-and-white Medicare card on hand to provide information like your Medicare number and your Medicare ...
Elder Law articles in the Medicare category. https://www.elderlawanswers.com/medicare ... Medicare. Learn who qualifies for Medicare, what the program covers, all about Medicare Advantage, and how to supplement ... Medicare. Learn who qualifies for Medicare, what the program covers, all about Medicare Advantage, and how to supplement ... Medicare Sued Over Failure to Set Up Appeals Process Three Medicare beneficiaries with a serious eye disease are claiming the ...
Babesiosis among Elderly Medicare Beneficiaries, United States, 2006-2008 Mikhail Menis. , Steven A. Anderson, Hector S. ... Highest babesiosis rates among elderly Medicare beneficiaries, by state, United States, 2006-2008* ... Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA (C.M. Worrall, J.A. Kelman) ... Babesiosis among Elderly Medicare Beneficiaries, United States, 2006-2008. ...
Once you pay the FEHBP premium and Medicare Part B premium (there is no premium for Part A if you or your spouse paid Medicare ... Such Medicare enrollment incentives can save the $4,000 to $5,000 that this retiree had to pay out of pocket in the past two ... Paying a Medicare Penalty Sometimes it makes sense, even if it costs you.. Tammy Flanagan ... Im healthy and I did not sign up for Medicare Part B when I turned 65 two years ago. In 2015 I had an emergency room visit and ...
Though the multiple parts of Medicare might seem confusing, mastering your benefits and using your coverage is surprisingly ... Medicare Part C, also known as Medicare Advantage, is a private alternative to Original Medicare (Parts A and B) offered by ... consult the official Medicare website or speak with a Medicare representative. Embrace the benefits of Medicare and secure your ... Compare Medicare Plans. If you decide not to enroll in Original Medicare, you should begin comparing your Part C policy options ...
For low-income Medicare beneficiaries, Medicaid fills the gaps in Medicare coverage by providing assistance for Medicare ... Current Proposals to Reform the Medicare Program. The Medicare Commission should be commended for its hard work on a vastly ... Medicare and Medicaid Program Dynamics. The Medicare program was originally intended to provide health insurance coverage for ... If Medicare is to add a drug benefit, it should be administered through the Medicare program, not merely delegated to the ...
Find the support and assistance you need with Anthems Medicare caregiver resources. Learn about extra care benefits, managing ... Exploring Medicare Options For Someone Else. Helping someone else make decisions about Medicare and their healthcare needs can ... Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross and Blue Shield is a ... Medicare Medicaid Federal Employees Employers Producers Providers Legal Disclosure Terms of Use Protecting Your Privacy ...
... About Medicare. Medicare is the federally sponsored fee-for-service health insurance program for people ... Traditional Medicare has two Parts: Medicare Part A (hospital insurance) and Medicare Part B (general medical insurance). ... Medicare beneficiaries may choose the services of any care provider whose services are recognized by Medicare. ... Under the policies developed by the Centers for Medicare and Medicaid Services (CMS), Medicare Part B coverage of chiropractic ...
... is a free and independent online reference tool to help people with Medicare navigate the complex world of health insurance. ... Medicare Advantage 101. New policy series from the Medicare Rights Center helps individuals better understand Medicare ... Medicare Interactive Pro. Medicare Interactive Pro (MI Pro) is an online curriculum designed to empower any professional to ... Use our free resources to learn more about Medicare. Choose the subject you want to learn about. ...
... put together resources to help everyone understand policies in order to help patients get qualified claims covered by Medicare ... Medicare Supplier Standards. Please note that this is an abbreviated version of the Supplier Standards every Medicare supplier ... MEDICARE DOCUMENTATION REQUIREMENTS. Enforcement of Medicares documentation requirements has become more stringent, and its ... or transition from Managed Medicare to traditional fee-for-service Medicare Part B, you may continue to be serviced by Apria ...
Leavitt said he believes the additional 2 million enrollees over the past month is a signal that Medicare beneficiaries see ...
Medigap policies help fill gaps in your Medicare plan. Learn about what health services it covers and how to apply with ... A Medicare Advantage Plan is different from Medigap insurance. Medicare Advantage gets you Medicare benefits, while Medigap ... Medicare supplements arent a necessity, but medical costs can add up quickly without them. Original Medicare doesnt have an ... To qualify for a Medigap plan, you must be enrolled in Original Medicare Parts A and B. Those with Medicare Advantage Plans do ...
Medicare is poised to overhaul the way it pays physicians and create new systems to reward high-performing doctors under ... Senate overhauls doctors Medicare payments in groundbreaking vote The Senate bill overhauling doctors medicare payments ... Mark McClellan, who oversaw Medicare as administrator of the Centers for Medicare and Medicaid Services, or CMS, in the ... Medicare is poised to overhaul the way it pays physicians and create new systems to reward high-performing doctors under ...
Medicare cuts are on the long list of policy disagreements between the two Republicans. Trump pledges not to cut Medicare. Ryan ... Medicare Trustees predict the Hospital Fund will go dry by 2030. Obamas Medicare cuts didnt help, because he spent the " ... President Obamas Medicare cuts are killing seniors. His health law changed Medicare, adding bonuses for hospitals that spend ... When Medicare was enacted in 1965, the law barred the government from interfering in how doctors treated patients. Over the ...
  • In 1988, the Health Care Financing Administration (HCFA) and CDC began a congressionally mandated 4-year demonstration project to evaluate the cost-effectiveness to Medicare of providing influenza vaccine to Medicare beneficiaries. (cdc.gov)
  • Before the 1990-91 and 1991-92 influenza seasons, the HCFA sent letters to all Medicare beneficiaries living in the intervention areas urging them to be vaccinated. (cdc.gov)
  • In addition, intervention sites undertook varied activities directed to both providers and patients to promote and distribute vaccine to Medicare beneficiaries (4). (cdc.gov)
  • Because some Medicare beneficiaries received influenza vaccines from sources not reimbursed by Medicare, annual surveys were conducted to accurately estimate vaccine coverage in each intervention and comparison site. (cdc.gov)
  • Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services. (cms.gov)
  • Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows beneficiaries to go to any doctor or hospital that accepts Medicare, anywhere in the United States. (aarp.org)
  • In 2017, most Medicare beneficiaries can choose from a variety of plans from at least six insurance companies. (aarp.org)
  • Medicare Advantage plans enrolled a record 9.8 million beneficiaries, more than one in five of the nation's 44 million people on Medicare as of April 2008. (kff.org)
  • That represents an increase of more than 800,000 beneficiaries in just four months, continuing a period of unprecedented growth for private plans in Medicare since 2003. (kff.org)
  • This issue brief, prepared for the Kaiser Family Foundation by Marsha Gold of Mathematica Policy Research, Inc., analyzes recent developments in the Medicare Advantage marketplace, including plan choices available to beneficiaries and enrollment trends by plan type and geography. (kff.org)
  • Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through private health insurance companies. (aha.org)
  • Three Medicare beneficiaries with a serious eye disease are claiming the Bush administration is violating the law by not allowing them to appeal its decision to deny coverage for a drug that could prevent them from going blind. (elderlawanswers.com)
  • Medicare officials have issued guidelines allowing homebound beneficiaries to leave their homes for special occasions--such as family reunions, graduations or funerals--without losing their home health care benefits. (elderlawanswers.com)
  • These programmatic changes will give states the ability to make meaningful changes in the Medicare and Medicaid programs that will not only improve health care for beneficiaries but actually save money at the state and federal levels. (nga.org)
  • Since 1988, the federal government has increasingly passed on to the states the responsibility to cover the cost-sharing responsibilities of many low-income Medicare beneficiaries (e.g., the Qualified Medicare Beneficiary Program, the Specified Low-Income Medicare Beneficiary Program, and the new groups of beneficiaries created by the BBA, the Qualifying Individuals). (nga.org)
  • Leavitt said he believes the additional 2 million enrollees over the past month is a signal that Medicare beneficiaries see value in the program. (foxnews.com)
  • To offset some of the more than $200-billion cost of the package, Democrats agreed to minor increases in cost-sharing for Medicare beneficiaries. (latimes.com)
  • 12. CMS announced a new initiative to improve care for Medicare beneficiaries with end-stage renal disease . (beckershospitalreview.com)
  • Indiana helps eligible, low-income beneficiaries pay for Medicare with the Medicaid program. (in.gov)
  • In fact, about 65% of doctors won't accept new Medicare patients, down from 71% 5 years ago, according to the Medscape Physician Compensation Report 2023 . (medscape.com)
  • In an Aug. 28 letter to House sponsors, the AHA voiced support for the GOLD Card Act of 2023 (H.R. 4968) that would exempt qualifying providers from prior authorization requirements under Medicare Advantage plans. (aha.org)
  • More New Yorkers are now eligible for the Medicare Savings Program in 2023. (medicareinteractive.org)
  • The Health and Human Services Office of Inspector General Aug. 28 released a strategic plan to align its audits, evaluations, investigations and enforcement of managed care plans in Medicare Advantage and Medicaid. (aha.org)
  • The Centers for Medicare & Medicaid Services (CMS) April 5 finalized its Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for contract year (CY) 2024. (aha.org)
  • The Centers for Medicare and Medicaid Services have scheduled a meeting on November 17 to discuss the proper use of Dendreon's prostate cancer treatment Provenge, a first-of-its kind cell therapy meant to train the immune system to attack prostate cancer cells. (forbes.com)
  • On Thursday, June 14, the Bush administration announced that it would rename the Health Care Financing Administration (HCFA) the Centers for Medicare and Medicaid Services (CMS). (elderlawanswers.com)
  • The primary concern for states in the Medicare reform debate is the issue of dual eligibility - the six million individuals eligible for both Medicare and Medicaid. (nga.org)
  • Beyond these specific changes, Governors ask that you remember the interrelation of the two programs and consider the potential implications for Medicaid before proposing changes to Medicare. (nga.org)
  • The lack of coordination between the Medicare and Medicaid programs contributes to the fragmentation of acute and long-term care. (nga.org)
  • Currently, it is impossible for Medicaid to participate in acute care decisions when Medicare is the primary payer. (nga.org)
  • Ultimately, poor clinical outcomes and service decisions that are reimbursement-driven lead to higher expenditures for both Medicare and Medicaid. (nga.org)
  • It's important legislation for moving away from fee for service," said Dr. Mark McClellan, who oversaw Medicare as administrator of the Centers for Medicare and Medicaid Services, or CMS, in the administration of President George W. Bush. (latimes.com)
  • Here are 18 issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. (beckershospitalreview.com)
  • 7. Healthcare spending on Medicare and Medicaid has grown slower than many have predicted, and the most recent report from the Congressional Budget Office showed federal spending for the two programs was 5 percent lower than it estimated in March 2010. (beckershospitalreview.com)
  • 15. Six lawmakers from both sides of the aisle released a report outlining recommendations from more than 160 stakeholders on methods to combat fraud and abuse in the Medicare and Medicaid programs . (beckershospitalreview.com)
  • Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills. (cdc.gov)
  • The Centers for Medicare & Medicaid Services (CMS) has planned similar cuts to retinal detachment repair codes, with reimbursement for CPT 67108 (repair of retinal detachment with vitrectomy) reduced by 33.6%, CPT code 67110 (pneumoretinopexy) reduced by 19%, and CPT code 67107 (retinal detachment repair/scleral buckle) reduced by 16% for 2016. (medscape.com)
  • Centres for Medicare and Medicaid Services (CMS). (who.int)
  • How do I enroll in Original Medicare? (aarp.org)
  • It's easy if you receive Social Security retirement benefits: The Social Security Administration will automatically enroll you in Medicare when you turn 65. (aarp.org)
  • If you are under 65 and get disability benefits, the Social Security Administration will enroll you in Medicare after you have received benefits for 24 months. (aarp.org)
  • Is enrollment in a Medicare Advantage plan automatic or do I need to enroll directly with the plan? (aarp.org)
  • Medicare doesn't automatically enroll you in a Medicare Advantage plan - you need to choose a plan and sign up directly. (aarp.org)
  • If your Medicare Advantage plan is ending at the end of the year, you can join another Medicare Advantage plan or enroll in original Medicare. (aarp.org)
  • Previously, they could enroll in only original Medicare and Medicare Part D. (healthline.com)
  • Generally, it's easy to enroll in Medicare. (govexec.com)
  • Check Section 9 of your FEHBP plan brochure for information about notification requirements when you enroll in Medicare. (govexec.com)
  • Eligibility begins the month you turn 65 and enroll in Medicare Part B. You have a right to purchase a Medigap policy during your open enrollment period, which lasts six months and can't be repeated. (consumeraffairs.com)
  • People with Medicare can enroll in a Medicare prescription drug plan and receive extra help paying for the premiums, deductibles, gaps in coverage and co-pays. (in.gov)
  • While these three doctors find Medicare lacking in its coverage of their specialty, and their reimbursements are too low, many physicians also find fault regarding Medicare billing, which can put their patients at risk. (medscape.com)
  • The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. (cms.gov)
  • The MSP provisions apply to situations when Medicare is not the beneficiary's primary health insurance coverage. (cms.gov)
  • Do you know that there are different ways you can get your Medicare health and prescription drug coverage? (aarp.org)
  • You can also get Medicare prescription drug coverage to help cover some of the costs of your prescription drugs. (aarp.org)
  • There are different parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). (aarp.org)
  • To get drug coverage under Original Medicare, you must choose and join a Medicare-approved Part D private drug plan. (aarp.org)
  • Do Medicare Advantage plans provide the same coverage as Original Medicare? (aarp.org)
  • You can change plans or join original Medicare once a year during the annual open enrollment period, from Oct. 15 through Dec. 7, and your new coverage will begin Jan. 1 of the following year. (aarp.org)
  • In this article, we look at Medicare coverage for insulin pumps and insulin. (medicalnewstoday.com)
  • We also discuss Medicare coverage for other diabetes-related supplies and services. (medicalnewstoday.com)
  • If a person has questions about the coverage of insulin, insulin pumps, or related supplies, they can call 1-800-MEDICARE. (medicalnewstoday.com)
  • Medicare Part B provides coverage for several types of diabetes-related services and equipment. (medicalnewstoday.com)
  • A person needs to get a written order from their doctor to get Medicare coverage. (medicalnewstoday.com)
  • These plans work in place of your original Medicare coverage. (healthline.com)
  • Many managed care plans offer coverage for services that original Medicare doesn't. (healthline.com)
  • Medicare care managed care plans are an optional coverage choice for people with Medicare. (healthline.com)
  • Managed care plans take the place of your original Medicare coverage. (healthline.com)
  • The Bush administration has decided to comply with federal law and authorize Medicare coverage for the treatment of Alzheimer's disease and other dementias. (elderlawanswers.com)
  • Medicare provides essential healthcare coverage for eligible individuals in the United States. (benzinga.com)
  • In this post, we will provide you with a comprehensive overview of Medicare benefits, outlining the different parts of the program and the coverage they offer. (benzinga.com)
  • Some plans may also include additional benefits not covered by Medicare Part A and B, such as prescription drug coverage (Part D), dental, vision, and hearing services. (benzinga.com)
  • Medicare Part D provides coverage for prescription medications that you pick up at a retail pharmacy. (benzinga.com)
  • While technically not a "Part" of Medicare, Medicare Supplement plans provide important coverage to warrant talking about. (benzinga.com)
  • Understanding the various parts of Medicare and their associated benefits is crucial to accessing the healthcare coverage you need. (benzinga.com)
  • Seniors are more likely to have health insurance coverage than any other group, and, together with Social Security, Medicare has drastically reduced the number of seniors living in poverty. (nga.org)
  • If you want coverage for these fees or other services that aren't covered by Original Medicare, consider getting a Medigap plan. (consumeraffairs.com)
  • Medicare Advantage gets you Medicare benefits, while Medigap supplements Medicare coverage. (consumeraffairs.com)
  • Plan B includes all the benefits of Plan A, plus coverage for Medicare Part A deductibles. (consumeraffairs.com)
  • Plan C builds on the benefits from plans A and B. It includes coverage for a skilled nursing facility and Medicare Part B deductible costs. (consumeraffairs.com)
  • It also adds coverage for excess charges from Medicare Part B. Your state may offer a high-deductible version of this plan. (consumeraffairs.com)
  • Enrollment in Medicare Part B through original Medicare (fee-for-service) or a Medicare Advantage (MA) plan. (cdc.gov)
  • This is a time outside of the yearly enrollment windows when you can change your Medicare plan. (healthline.com)
  • I told her it might be worth paying for Medicare Part B even though there is a penalty since she missed the initial enrollment period that started when she turned 65. (govexec.com)
  • Such Medicare enrollment incentives can save the $4,000 to $5,000 that this retiree had to pay out of pocket in the past two years for her medical care. (govexec.com)
  • The legislation also marks a milestone in the push to modernize Medicare, the nation's mammoth federal insurance program for the elderly, and move it away from the traditional system of paying physicians for every procedure they perform. (latimes.com)
  • If you have a Medicare Advantage plan, you cannot buy a Medicare Supplement Insurance or Medigap plan. (aarp.org)
  • What is Medicare Supplement Insurance (Medigap)? (consumeraffairs.com)
  • Medigap, also called Medicare supplemental insurance , is offered by private insurers to cover costs not covered by Original Medicare. (consumeraffairs.com)
  • Medigap can help pay for costs outside of Original Medicare, such as deductibles and copayments. (consumeraffairs.com)
  • To qualify for Medigap, you must currently have Medicare Part A and Part B. (consumeraffairs.com)
  • A Medicare Advantage Plan is different from Medigap insurance. (consumeraffairs.com)
  • Medigap is another term for Medicare supplemental insurance. (consumeraffairs.com)
  • Private insurance companies sell Medigap plans to cover the things that are left out of government-backed Medicare plans. (consumeraffairs.com)
  • Medigap plans sold after 2006 do not include prescription drugs and can only be paired with Original Medicare, not Medicare Advantage. (consumeraffairs.com)
  • Medigap, also called Medicare supplemental insurance, is sold by private companies. (consumeraffairs.com)
  • To qualify for a Medigap plan, you must be enrolled in Original Medicare Parts A and B. Those with Medicare Advantage Plans do not qualify. (consumeraffairs.com)
  • The legislation places new, although limited, restrictions on popular insurance policies known as Medigap plans that millions of seniors buy to help pay for out-of-pocket medical expenses not covered by Medicare. (latimes.com)
  • Medicare sets the tone on price and reimbursement, and everyone follows suit," Gupta said. (medscape.com)
  • Because claims are processed by Medicare administrative contractors, it can take about a month for the approval or denial process and for doctors to receive reimbursement. (medscape.com)
  • introduced new legislation that would permanently repeal the sustainable growth rate , which dictates Medicare reimbursement to physicians. (beckershospitalreview.com)
  • That's the prediction from some advocates for the profession who say that a series of unprecedented cuts to Medicare reimbursement for glaucoma and retinal detachment surgery may change the way physicians approach these conditions. (medscape.com)
  • In the Achieving a Better Life Experience Act of 2014, Congress required the CMS to identify "misvalued" CPT codes and reduce reimbursement for those that are overvalued with a target of reductions equaling 1% of total physician Medicare reimbursements for calendar year 2016 and 0.5% for each of 2017 and 2018. (medscape.com)
  • Cite this: How Medicare Reimbursement Cuts Are Reshaping Ophthalmology - Medscape - Dec 23, 2015. (medscape.com)
  • However, over the years, with new developments in medicine and the explosion of the Medicare-eligible population, the program hasn't kept up with coverages. (medscape.com)
  • One of the biggest changes is that people who are eligible for Medicare through a diagnosis of end stage renal disease (ESRD) are now able to purchase a managed care plan. (healthline.com)
  • With more than 1,800 managed care contracts nationwide, should you become Medicare-eligible, or transition from Managed Medicare to traditional fee-for-service Medicare Part B, you may continue to be serviced by Apria without interruption. (apria.com)
  • Medicare doesn't cover eye health (except for eye exams for diabetes patients), which is an issue for Daniel Laroche, MD, a glaucoma specialist and clinical associate professor of ophthalmology at Mount Sinai Medical Center in New York City. (medscape.com)
  • For example, as per Medicare , after patients meet their Part B deductible, they pay 20% of the Medicare-approved amount for glaucoma testing. (medscape.com)
  • If a person has diabetes and a high chance of developing glaucoma , original Medicare Part B will cover an annual eye exam. (medicalnewstoday.com)
  • A person will generally pay the deductible for Part B, then 20% of the Medicare-approved amount. (medicalnewstoday.com)
  • Plan D has the same benefits as plans A, B and C, except for Medicare Part B deductible costs. (consumeraffairs.com)
  • Congress has passed legislation allowing enrollees in Medicare managed care plans to return to regular Medicare or change plans at any time over the next three years, delaying restrictions that were scheduled to take effect this year. (elderlawanswers.com)
  • Original Medicare takes care of many health costs and services, but there are a few things it doesn't cover, like copays, coinsurance and deductibles. (consumeraffairs.com)
  • Medicare supplemental insurance helps cover copayments, coinsurance and deductibles. (consumeraffairs.com)
  • Plan A pays for Medicare Part A coinsurance, hospital costs and hospice costs. (consumeraffairs.com)
  • Medicare Part B does not cover insulin unless a person is medically required to use an insulin pump. (medicalnewstoday.com)
  • 3. CMS announced changes to its Medicare Medically Unlikely Edits program, which screens claims for likely errors under Part B to avoid excess payments. (beckershospitalreview.com)
  • Medicare is the U.S. government's health insurance program for people age 65 or older. (medlineplus.gov)
  • Medicare helps with the cost of health care. (medlineplus.gov)
  • But there's help at hand-you can join the Medicare Diabetes Prevention Program (MDPP) and lower your risk of type 2 diabetes, improve your health, and build healthy habits that last a lifetime. (cdc.gov)
  • In intervention areas, influenza vaccine was supplied without cost to Medicare providers by local health departments using computerized vaccine monitoring and distribution systems. (cdc.gov)
  • Original Medicare provides many health care services and supplies, but it doesn't pay all your expenses. (aarp.org)
  • Medicare Advantage plans are sold by Medicare-approved private insurance companies and must cover the same health care services as original Medicare (except hospice care). (aarp.org)
  • To begin your search for a plan, use the Medicare Plan Finder at www.medicare.gov/find-a-plan , or contact your local State Health Insurance Assistance Program (or SHIP) at www.shiptacenter.org. (aarp.org)
  • Medicare may cover diabetes self-management training if a person is at risk of health complications due to the condition. (medicalnewstoday.com)
  • The brief also examines market share for the companies offering Medicare Advantage plans and the role Medicare Advantage plans play in providing employer-sponsored retiree health benefits. (kff.org)
  • The outbreak of severe acute respiratory syndrome (SARS) this spring awakened policymakers' attention to health and medicare problems for rural people. (chinadaily.com.cn)
  • A federal district judge has ruled that the Bush administration violated federal law by failing to send comparative information on the available Medicare health plans to each beneficiary last year. (elderlawanswers.com)
  • Medicare Part A covers hospital services, skilled nursing facility care, hospice care, and some home health services. (benzinga.com)
  • Medicare also typically covers short-term home health services if a doctor prescribes care for a person who is homebound. (anthem.com)
  • His health law changed Medicare, adding bonuses for hospitals that spend the least per senior. (gopusa.com)
  • Obama's Medicare cuts didn't help, because he spent the "savings" on his costly health law. (gopusa.com)
  • Obamacare overhauls how Medicare pays doctors and hospitals. (gopusa.com)
  • When Medicare began in 1966, it was the primary payer for all claims except for those covered by Workers' Compensation, Federal Black Lung benefits, and Veteran's Administration (VA) benefits. (cms.gov)
  • In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. (cms.gov)
  • Medicare is poised to overhaul the way it pays physicians and create new systems to reward high-performing doctors under legislation approved by the Senate late Tuesday. (latimes.com)
  • The reductions may come as a surprise to anyone who has not been closely following the twists and turns of federal Medicare legislation. (medscape.com)
  • Part C is called Medicare Advantage. (medlineplus.gov)
  • Some Medicare Advantage plans do. (medscape.com)
  • Prior authorizations, especially with Medicare Advantage plans, are also problematic. (medscape.com)
  • Or, you can choose Medicare Advantage (also known as Part C). (aarp.org)
  • What is Medicare Advantage? (aarp.org)
  • Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare. (aarp.org)
  • Do Medicare Advantage plans include both Part A and Part B? (aarp.org)
  • Where do I find information about the Medicare Advantage plans in my area? (aarp.org)
  • Medicare Advantage plans are available in most parts of the United States. (aarp.org)
  • How are Medicare Advantage plans different from Original Medicare? (aarp.org)
  • I have a Medicare Advantage plan. (aarp.org)
  • Medicare Advantage plans cover all Medicare-covered services and must include both Part A and Part B benefits. (aarp.org)
  • Before you choose a Medicare Advantage plan, consider carefully the many options these plans offer. (aarp.org)
  • What are my options if my Medicare Advantage plan is ending at the end of this year? (aarp.org)
  • If I have problems with my Medicare Advantage plan, can I switch plans? (aarp.org)
  • Medicare managed care plans are often known as Medicare Part C or Medicare Advantage plans. (healthline.com)
  • Medicare managed plans are an alternative to original Medicare (parts A and B). Sometimes referred to as Medicare Part C or Medicare Advantage, Medicare managed care plans are offered by private companies. (healthline.com)
  • Managed care plans are also referred to as Medicare Part C (Medicare Advantage) plans. (healthline.com)
  • Medicare Part C, also known as Medicare Advantage, is a private alternative to Original Medicare (Parts A and B) offered by private insurance companies. (benzinga.com)
  • Medicare Advantage plans combine the benefits covered under Parts A and B into a single plan. (benzinga.com)
  • Medicare Advantage plans typically have a network of preferred healthcare providers, offering coordinated care and potentially lower out-of-pocket costs. (benzinga.com)
  • Whether you choose Original Medicare (Parts A and B) or opt for the added benefits of Medicare Advantage (Part C), there are options to suit your specific healthcare needs. (benzinga.com)
  • Plus, there are Medicare Advantage plans that include extras such as meal deliveries, home helpers, and transportation to doctor appointments. (anthem.com)
  • New policy series from the Medicare Rights Center helps individuals better understand Medicare Advantage and its role within the Medicare system. (medicareinteractive.org)
  • But year after year, as automatic cuts threatened to slash Medicare fees, physician groups warned of dire consequences for medical practices and patients, setting off repeated scrambles in Congress to override the mandated limits. (latimes.com)
  • AARP's Medicare Question and Answer Tool is a starting point to guide you through the different Medicare plans. (aarp.org)
  • The private plans operate differently from original Medicare in several ways. (aarp.org)
  • Medicare managed care plans are offered by private companies that have a contract with Medicare. (healthline.com)
  • Plans are offered by private companies overseen by Medicare. (healthline.com)
  • For example, plans must cover all the same services as original Medicare. (healthline.com)
  • What are the types of Medicare managed care plans? (healthline.com)
  • You can choose from among a few kinds of Medicare managed care plans. (healthline.com)
  • There are a few changes to Medicare managed care plans in 2021. (healthline.com)
  • Which parts of Medicare are included in managed care plans? (healthline.com)
  • These plans cover everything original Medicare does, and they often cover additional services as well. (healthline.com)
  • Medicare Supplement plans are private insurance plans that you can purchase to help cover the 'gaps' or out of pocket costs you owe under Original Medicare (Part A and B). (benzinga.com)
  • The bill also subjects the small number of seniors with individual incomes between $133,500 and $214,000 or joint incomes between $267,000 and $428,000 to higher Medicare Part B premiums. (latimes.com)
  • Republican proposals, like raising the eligibility age, asking wealthier seniors for higher premiums and adding private plan options, would help keep Medicare solvent. (gopusa.com)
  • When Medicare started, the concept of the program was good," said Rahul Gupta, MD, a geriatrician in Westport, Connecticut, and chief of internal medicine at St. Vincent's Medical Center in Bridgeport. (medscape.com)
  • Taking part in Medicare Diabetes Prevention Program (MDPP) can make all the difference, and with Medicare Part B, it's free! (cdc.gov)
  • Criticized as needlessly confusing, the new Medicare prescription-drug program, Medicare Part D, went into effect this week. (theonion.com)
  • Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare. (cms.gov)
  • To this end, the Medicare program has been tremendously successful. (nga.org)
  • Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. (in.gov)
  • Indiana's State Pharmaceutical Assistance Program, HoosierRx, can help pay the monthly Part D premium, up to $70 per month, for members enrolled in a Medicare Part D Plan working with HoosierRx. (in.gov)
  • The system, known as the Sustainable Growth Rate formula, was designed to control Medicare spending by limiting annual increases in physicians' reimbursements. (latimes.com)
  • While physicians are getting less of a Medicare pay cut than they thought this year (Congress voted to cut Medicare payments by 2%, which was less than the expected 8.5%), Medicare still pays physicians only 80% of what many third-party insurers pay. (medscape.com)
  • Ryan and GOP members of Congress are pushing to repeal Obamacare but want to keep Obama's Medicare cuts. (gopusa.com)
  • 1. CMS issued its annual Medicare Recovery Auditor report to Congress, confirming that recovery audit contractors collected $797.4 million in overpayments from hospitals and other providers and repaid $141.9 million in underpayments in fiscal year 2011. (beckershospitalreview.com)
  • The new Medicare plan is far too difficult to make sense of, which is why I have chosen to die earlier than I had initially planned. (theonion.com)
  • This is the traditional fee-for-service plan provided by Medicare. (aarp.org)
  • You get Part A and Part B of the Original Medicare plan when you're automatically signed up for Medicare. (aarp.org)
  • Apparently, even though I signed up for Part B Medicare as of Oct. 1 after retiring as of Sept 30, I didn't know that I had to notify my FEHBP plan that I'd retired and now had Part B as primary. (govexec.com)
  • Comparing Anthem's Medicare plan types and their benefits can also help you and your loved ones understand options that might be a good fit. (anthem.com)
  • If you're providing care and support to someone with an Anthem Medicare plan, you can be added as a caregiver to their account. (anthem.com)
  • A no-charge informational presentation of Medicare Basics, the options available to you, and how to choose the Medicare Plan that will be best for your needs. (westseattleblog.com)
  • Worse, inflation makes continuous cuts feel even steeper and trickles down to physicians and their patients as more and more doctors become disenchanted and consider dropping Medicare. (medscape.com)
  • President Obama's Medicare cuts are killing seniors. (gopusa.com)
  • Medicare cuts are on the long list of policy disagreements between the two Republicans. (gopusa.com)
  • The truth is, Trump vows to undo Obamacare's Medicare cuts. (gopusa.com)
  • Republicans should repeal all of Obamacare, including the Medicare cuts, so seniors will get the care they need. (gopusa.com)
  • It's Obamacare lite - a new entitlement paid for by continuing the Medicare cuts. (gopusa.com)
  • Any additional testing requires authorization, and Medicare doesn't cover hormone replacement at all, which really makes me crazy. (medscape.com)
  • Helping someone else make decisions about Medicare and their healthcare needs can be challenging. (anthem.com)
  • President Obama said he would be proud to sign the bill, calling it "a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their healthcare needs. (latimes.com)
  • Medicare pays physicians about 80% of the "reasonable charge" for covered services. (medscape.com)
  • Physicians who accept Medicare can choose to be a "participating provider" by agreeing to the fee schedule and to not charging more than this amount. (medscape.com)
  • Physicians can also opt out of Medicare entirely. (medscape.com)
  • Physicians lose an estimated 7.3% of Medicare claims to billing problems. (medscape.com)
  • The unusually bipartisan bill, which passed the House easily last month, will immediately lift the threat of an automatic 21% cut in Medicare fees to physicians, which was set to take effect Wednesday. (latimes.com)
  • Potentially more important, the bill creates new incentives in Medicare to pay physicians based on their performance, rewarding doctors who hit quality targets and whose patients get healthier and effectively penalizing those who do not. (latimes.com)
  • What Is Medicare Managed Care? (healthline.com)
  • In general, Medicare doesn't cover expenses for in-home caregivers to provide personal care and housekeeping, if medical care isn't needed. (anthem.com)
  • Medicare does cover short-term caregiving expenses if someone needs medical care following a surgery, illness, or injury. (anthem.com)
  • With the largest network of insurance payors - including Medicare, Commercial and Managed Care expertise - Apria's team will work proactively with your insurance carrier and work on your behalf to get equipment and services covered. (apria.com)
  • Extensive Medicare experience as well as the largest network of payor contracts, helps ensure that Apria is positioned to provide care to more patients than any other healthcare provider. (apria.com)
  • The report found that 231 hospitals rewarded with Medicare bonuses for low spending per senior provide inferior care. (gopusa.com)
  • Sec. 3001 of The Affordable Care Act claims to tie these bonuses to "quality" but hospitals can win the most points - and biggest Medicare bonuses - by spending the least. (gopusa.com)
  • and Tom Coburn, MD (R-Okla.), introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act - a controversial provision that sets the Medicare hospital wage index floor for the entire country. (beckershospitalreview.com)
  • The cost-effectiveness indices were calculated using morbidity and mortality data from the demonstration and published studies and compared with cost-effectiveness of other Medicare benefits. (cdc.gov)
  • Read on to gain insight into the valuable healthcare benefits available through Medicare. (benzinga.com)
  • In this case, Medicare considers the pump to be durable medical equipment (DME). (medicalnewstoday.com)
  • Results show that over the period from 2010-2019, anesthesia delivery models utilized under Medicare Part B have become increasingly oriented around the use of CRNAs. (bvsalud.org)
  • The heartless ones are the Democrats, who are willing to slash Medicare to pay for Obamacare. (gopusa.com)
  • In addition, Medicare has given American families the assurance that they will not have to bear by themselves the burden of illness of their elderly or disabled parents or other family members. (nga.org)
  • You can choose Original Medicare. (aarp.org)
  • For guidance that's geared toward the needs of loved ones considering Medicare, choose one of the following options that best describes their situation. (anthem.com)
  • Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). (healthline.com)
  • Original Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). (healthline.com)
  • Two new consumer booklets from the Medicare Rights Center explain how Medicare dovetails with private insurance and how to appeal Medicare decisions. (elderlawanswers.com)
  • Over the years, I've written a number of columns about the wisdom of enrolling in "original Medicare" - Part A (hospital Insurance) and Part B (medical insurance). (govexec.com)
  • Once you pay the FEHBP premium and Medicare Part B premium (there is no premium for Part A if you or your spouse paid Medicare taxes while working), your only other out of pocket expenses will be prescription drug copays (which are sometimes less expensive if you are enrolled in Part B) and dental and vision costs. (govexec.com)
  • Medicare Part D helps reduce out-of-pocket expenses on prescription drugs. (benzinga.com)
  • At the same time, private insurers pay nearly double Medicare rates for hospital services. (medscape.com)
  • What other diabetes services does Medicare Part B cover? (medicalnewstoday.com)
  • Working together, we can help your patients get the equipment and services they need, while ensuring that Medicare guidelines are met. (apria.com)
  • While many of the Commission's proposals are not fully formed, and NGA does not have an official position on them, there are certain basic considerations that must be included in any discussion of Medicare reform. (nga.org)
  • But one lesson they must take away from the grim report on hospital skimping: Medicare reform should not cost seniors their lives. (gopusa.com)
  • These companies have a contract with Medicare and need to follow set rules and regulations. (healthline.com)
  • 10. HHS and CMS issued a proposed rule that would modify or eliminate Medicare regulations deemed to be unnecessary or obsolete - reforms the government expects will save hospitals and healthcare providers up to $676 million per year and $3.4 billion over five years. (beckershospitalreview.com)
  • This evaluation does not prevent Medicare patients from getting Provenge, and all but one of the 15 Medicare contractors that make these decisions are covering the product, according to Dendreon. (forbes.com)
  • If a person meets the criteria, Medicare Part B will cover insulin pumps and insulin, while Part D will cover prescribed insulin and related medical supplies. (medicalnewstoday.com)
  • China is launching an unprecedented project to build up a cooperative medicare system within eight years in rural areas, which will cover 900 million farmers with medical financial assistance and free them from worries of being unable to afford a cure. (chinadaily.com.cn)
  • Under this new medicare system, cooperative medical funds will be set up in rural areas with money from three parties: the central government, local governments and farmers themselves. (chinadaily.com.cn)
  • We are committed to maintaining close ties with the medical community and to serving as an ongoing source of information when it comes to Medicare documentation requirements. (apria.com)
  • Does Medicare cover insulin pumps? (medicalnewstoday.com)
  • If a person's doctor believes that it is necessary, Medicare may cover two screenings per year. (medicalnewstoday.com)
  • If a person has nerve damage in one or both feet due to diabetes, Medicare Part B may cover a foot exam every year . (medicalnewstoday.com)
  • If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. (medicalnewstoday.com)
  • The central government was determined to set up an effective cooperative system to offer medicare for 900 million farmers and the system is scheduled to be expanded to cover all farmers by 2010. (chinadaily.com.cn)
  • They're required to cover everything original Medicare does, and they often cover more. (healthline.com)
  • Medicare only covers gynecologist visits every 2 years after the age of 65," she said. (medscape.com)
  • Medicare will pay its share of the charge for each service it covers. (aarp.org)
  • Medicare Part D , which covers prescription drugs, also covers diabetes supplies. (medicalnewstoday.com)
  • Part B of original Medicare generally covers 100% of the Medicare-approved cost for diabetes screenings. (medicalnewstoday.com)
  • Does Original Medicare automatically include Part A, Part B and Part D? (aarp.org)
  • So much for Obama's promise that cutting Medicare wouldn't harm seniors. (gopusa.com)
  • Instead, for a present price, you can see any doctor who contracts with Medicare. (healthline.com)
  • The Medicare fee schedule is released each year. (medscape.com)
  • The number of doses of vaccine administered during the 4-year demonstration and the percentage of the Medicare population vaccinated in the intervention areas increased from 477,316 (26%) during 1989-90 (the first full year of the project) to 995,884 (51%) during 1991-92. (cdc.gov)