By Diane Daniels
The podcast currently has 98 episodes available.
Hey Medicare Nation!
www.TheMedicareNation.com
Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020!
THREE more plan sponsors to discuss!
CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00!
HUGE Penalty people!
According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees.
HCSC has the right to Appeal CMS Decision.
NEXT Up..... is Triple-S Management Corporation!
CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020.
CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00!
CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration.
Triple-S has the right to Appeal CMS decision.
Last up..... is Tufts Health Plan, Inc.
CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00.
CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations.
Tufts has the right to Appeal CMS' decision.
If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call.
You can request a "Special Election Period," based on your experience with any of these companies.
Call Medicare at 800 - 633 - 4227 24hrs a day, 7 days a week.
www.TheMedicareNation.com
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Hey Medicare Nation!
www.TheMedicareNation.com
It’s April 1st and over One Million People have been diagnosed with the COVID-19 Virus Worldwide!
On this week’s episode….. I provide a time-line of the events of the Pandemic as well as updates on COVID-19 testing and Important phone numbers should you have symptoms or questions about COVID-19.
I also have a “list” of phone numbers, for EACH Health Department in All 50 States!
You can email me at [email protected] for the list or check the show notes for an attachment.
Here is an important phone number for the CDC HOTLINE on COVID-19
800 -232- 4636 - CDC Hotline
Advent Health 24hr Hotline - 877 – 847 – 8747
You can also download the Advent Health App on iTunes or Google Play in order to have a “Virtual” visit with an Advent Health Doctor.
Bay Care Virtual Doctor Hotline - 800 – 229 – 2273
You can also go to this website for a “virtual” visit with a Bay Care Doctor –
www.BayCareAnywhere.org
The Florida Department of Health Hotline is
866 – 779 – 6121
State Health Department List of Phone Numbers
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Contact Me!
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Hey Medicare Nation!
We're smack in the middle of a Corona Virus Pandemic!
The Medicare Nation
I wanted to give you an episode that is full of USEFULL information. I know you've been hammered by the news, internet and newspapers about the Corona Virus.
Let's start with a very important fact:
Human coronaviruses were first identified in the mid-1960s.
The 1960's people!
the coronavirus gets its name from a distinctive corona or in a scientists world…a “Crown of Sugary Proteins,” that projects from the surface of the virus.
There are four main types of Human Corona Viruses
The first two only infect mammals, including bats, pigs, cats, and humans.
Gammacoronavirus mostly infects birds such as poultry (chickens) and Deltacoronavirus can infect both birds and mammals.
Do you recognize the Virus named SARS?
Severe acute respiratory syndrome abbreviated as …. (SARS-CoV)SARS-CoV (the beta coronavirus. Guess what it causes? It causes severe… acute…..respiratory syndrome,
SARS was first recognized as a distinct strain of coronavirus in 2002. The source of the virus has never been clear, though the first human infections can be traced back to the Chinese province of Guangdong in November of 2002.
The virus then became a pandemic, causing more than 8,000 infections of an influenza-like disease in 26 countries with close to 800 deaths.
In the United States, only eight persons were laboratory-confirmed as SARS cases. There were NO SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.
By July of 2003….. the World Health Organization declared the outbreak over.
On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is….SARS-COV-2 aka coronavirus disease 2019, abbreviated as COVID-19. ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease.
The Medicare Nation
COVID-19 is a new disease, caused by a novel (or new) “coronavirus” or strain of “Corona Virus” that has not previously been seen in humans.
What are the Symptoms of COVID-19?
The CDC (Centers of Disease Control) have listed these as the most common symptoms of COVID-19:
Symptoms may appear 2-14 days after exposure.
Reported illnesses have ranged from mild symptoms….like a dry cough….
to severe illness, with high fever and shortness of breath, requiring hospitalization and there have been deaths reported for confirmed coronavirus disease 2019 (COVID-19) cases.
Currently……according to the WHO… as of March 13th….there are over 132, 758 reported cases of COVID-19 …. Worldwide.
Of those cases….. there are 4,955 Deaths worldwide.
Over 80% of the reported cases are recovering.
In the U.S…… there are currently 1,629 reported cases…… in 47 of the 50 States.
No reported cases yet….in Idaho, Alabama and West Virginia.
There have been 41 Deaths reported in the U.S. ….. with 37 Deaths coming from the State of Washington. The deaths mainly being reported from a nursing facility, with those being elderly and having underlying medical conditions prior to contracting the CoronaVirus.
What do we mean by Underlying medical conditions????
If you have a blood disorder.... like sickle cell disease... or ... you have chronic kidney disease.... you're currently receiving chemotherapy or radiation. You may have congestive heart failure or coronary artery disease.
You may have chronic asthma or chronic obstructive pulmonary disease or you may need oxygen at home.
All of these conditions..... as well as many more..... may raise your risk of contracting COVID-19. You may NOT contract the virus. Just be more cognizant of your surroundings and who you are in contact with.
What do you do if you believe you have symptoms of the COVID-19?
IF You CANT get Through to your Doctor…….
If you do have symptoms, and your doctor wants you to have the test to confirm COVID-19…. Where do you go??
According to the FDA….. here is the current list of laboratories across the U.S. that will be offering testing for the COVID-19 very soon
Advent Health Laboratories
Lab Corp
Quest Laboratories
As well as many other public health, university and private labs will be available on the FDA list of laboratories to test for the COVID-19.
Medicare IS Covering the Test for COVID-19 as a Preventative Diagnostic Test….and therefore ….. you will have NO COPAY when you take the test.
There are currently TWO Testing Codes for the COVID-19 Test
If you are diagnosed with COVID-19, self-quarantine yourself in your home, away from your family members and pets, until you have tested negative.
We ALL need to SELF-Police ourselves and HELP STOP the Spread of COVID-19….. so we can curtail the spread and help stop the pandemic.
Remember to Drink lots of fluids….. eat plenty of chicken soup and crackers ….. and get lots of REST!!
The Medicare Nation
You can go to the Center for Disease Control website for daily updates on the Corona Virus 19 situation ….. go to….. www.CDC.gov
You can also go to the World Health Organization website…. Go to …. www.who.int
AND…. PLEASE go to your STATE”S Health Department website for local information by “Googling” your State.
That’s all for today Nation. Call your Parents….. Make sure they’re ok and help them subscribe to Medicare Nation…. So they can hear this episode as well as over 100 other episodes about Medicare and it’s Resources.
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Hey Medicare Nation!
www.TheMedicareNation.com
It's still January...but February is right around the corner. Spring WILL come. I promise!
Let me give you some good news!
Medicare is now covering Acupuncture!
As of January 21, 2020, The Center for Medicare & Medicaid Services (CMS), will cover acupuncture for "Chronic Low Back Pain."
Let's look at the coverage in the Medicare National Coverage Determination Manual.
Section 1862(a)(1)(A) of the Social Security Act
Up to "12" visits in 90 days are covered for Medicare Beneficiaries under the following circumstances:
a. Chronic Low Back Pain which lasts "12 weeks or longer,"
b. the Chronic Low Back Pain is "non-specific," in that it has NO identifiable systemic cause (NOT associated with metastatic, inflammatory, infectious, disease).
c. the Chronic Low Back Pain is NOT associated with surgery
d. the Chronic Low Back Pain is NOT associated with pregnancy.
An ADDITIONAL "Eight" (8) sessions WILL be covered for those patients demonstrating an improvement.
No more than "20" acupuncture treatments may be administered annually.
Treatment MUST be discontinued if the patient is NOT improving or is regressing.
The Acupuncture must be Administered under the supervision of a doctor of medicine or osteopathy.
Need more information? Check out our website www.TheMedicareNation.com
What plans cover Acupuncture?
Acupuncture for Chronic Low Back Pain, will be covered under ORIGINAL Medicare.
If you present your Medicare ID Card to providers as your Health Insurance..... You may start utilizing this treatment now.
If you present your Medicare ID Card, as well as a Medi-Gap (Medicare Supplement) Plan..... You may start utilizing this treatment now.
If you have a Medicare Advantage Plan, you need to check your Summary of Benefits Book under your plan, to see if they cover Acupuncture. If you can't find it.... call the customer service number on the back of your ID Card and ask the representative.
Acupuncture is NOT covered under Medicare Part D. Part D is ONLY for Prescription Drug Coverage.
If you have any questions.... send them to [email protected]
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Diane Daniels Medicare Consultant
[email protected]
Hey Medicare Nation!
www.TheMedicareNation.com
It's 2020! Love the sound of that!
Right now...... the Medicare Advantage Open Enrollment Period is in full swing.
If you are on a "Medicare Advantage Plan," you have the opportunity to make a ONE TIME change, between January 1st through March 31st.
You can change from one Medicare Advantage Plan to another Medicare Advantage Plan.
You can "disenroll" from the Medicare Advantage Plan you're on and go back onto "Original Medicare." With Original Medicare, you can add a stand-alone-prescription drug plan and ..... you can enroll into a Medicare Supplement Plan (aka Medi-gap) to help defray the costs of Original Medicare.
Here are options you can do during the Medicare Advantage Open Enrollment Period:
I'm adding the EXACT language from the Medicare Managed Manual, regarding the Medicare Advantage Open Enrollment Period.
30.5 – Medicare Advantage Open Enrollment Period (MA OEP) 42 CFR 422.62(a)(3) (Rev. 1, Issued: July 31, 2018; Effective/Implementation: 01-01-2019)
During the MA OEP, MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during the MA OEP.
This chart outlines who can use the MA OEP and when: Who can use the MA OEP: MA OEP occurs:
Individuals enrolled in MA plans as of January 1 – March 31 New Medicare beneficiaries who are enrolled in an MA plan during their ICEP The month of entitlement to Part A and Part B – the last day of the 3rd month of entitlement
Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MAPD or MA-only plans can switch to: • MA-PD • MA-only • Original Medicare (with or without a stand-alone Part D plan)
The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.
NOTE: The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE).
You may also go onto Medicare.gov to view information on the Medicare Advantage Open Enrollment Period.
If you decide to make a change during the MA OEP, you will be "locked-in" to the new plan, until the next enrollment period.... which is....the Annual Enrollment Period, from October 15th through December 7th.
You may also make a change to your plan if you have a "special circumstance."
These are listed under the "Special Election Periods" for Medicare on Medicare.gov
You can also LISTEN to my previous show on Special Election Periods..... Episode 051, which was published on July 29, 2016. The episode is titled..... "Special Election Period Q & A"
I go into detail about the Special Elections available.
www.TheMedicareNation.com
Remember Medicare Nation listeners........ an "Insurance Agent," is NOT allowed to "solicit" you during the Medicare Advantage Open Enrollment Period.
There are strict Medicare regulations regarding this.
YOU must make the first move in contacting or telling your "Agent" or Medicare Specialist, that you are unhappy with your current plan.
No one should be calling you, texting you, emailing you ..... or worse...... knocking on your door, telling you about the Open Enrollment Period. If someone does...... tell them to "Take a Hike!" You don't need a dishonest person like that helping you with your Medicare needs!
If you need help finding a new plan during the OEP, contact you're Medicare Advisor.
If you are all set with your Medicare Advantage Plan for 2020, You don't need to do anything! Just enjoy your family, friends and activities!
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Contact me on my website - www.TheMedicareNation.com
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Diane Daniels Medicare Consultant Medicare Nation LLC.
Hey Medicare Nation!
CMS just announced the 2020 Medicare Part B Premium increase!
CMS also announced 2020 Part A Deductible and co-pays, as well as the Part B annual deductible.
Here's a look at what's changing in 2020:
Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Soc Sec Act.
SOCIAL SECURITY
Increase: 1.6% (Avg $24 more a month)
Average Monthly SS Check $1,503.00
2020 - PART A DEDUCTIBLE AND COINSURANCE
Inpatient Hospital Deductible: $1408.00
Daily Coinsurance Days 61-90: $ 352.00
Daily Coinsurance-Lifetime Reserve: $ 704.00
Skilled Nursing Facility-Days 21-100: $ 176.00
2020 - PART B PREMIUM AND ANNUAL DEDUCTIBLE
Standard Monthly Premium: $ 144.60 ($9.00 More)
Annual Deductible: $ 198.00
It's a great time to review your plan for 2020.
Is it the right plan to fit your unique needs?
If so........ keep it!
If not....... change it!
I am available to assist you with your Medicare Plan choices for 2020.
If I can answer your email in one paragraph or less, I WILL answer your question for you!
If the answer to your question requires any research or my response is longer than one paragraph..... I will let you know that you will need to hire me to answer that question.
If you live outside of Florida, you can hire me as your consultant at a rate of $200.00 an hour ( The hourly rate is going up to $250.00 an hour, starting January 1 2020).
If you are a Florida resident, I can assist you in enrolling into the plan that fit's your unique needs at no additional charge. I will receive a commission from the insurance carrier once you are enrolled. The commission is regulated by Medicare.
The Annual Enrollment Period ends December 7th, so make sure you do your "due dilligence" and find the plan that works for you!
Until next time..... Have a Happy, peaceful & prosperous week!
Diane Daniels
Medicare Consultant
855-855-7266
Hey Medicare Nation!
www.TheMedicareNation.com
It's October! That means it's Medicare Time!
The Annual Enrollment Period is just around the corner. Did you receive your "Annual Notice of Changes (ANOC)" for your Medicare Advantage Plan or Prescription Drug Plan?
If not....contact your plan and request the ANOC.
Today......I want to talk with you about Part D Prescription Drug Coverage for 2020!
Medicare has set the maximum Part D Deductible for 2020 at $435.00.
Medicare Advantage Plans and Stand-Alone Prescription Drug Plans have the option to charge the maximum deductible amount of $435.00......
or.......
They can eliminate the Deductible altogether....
or......
They can charge an amount in between.
You MUST do your "Due Dilligence" in determining which Prescription Drug Plan will fit your unique needs for 2020.
Contact your Medicare Specialist and request their assistance in finding a Prescription Drug Plan for 2020.
If you have a question about Medicare or your Prescription Drug Plan....
You can send me an email to [email protected]
If I can answer your question in ONE Paragraph, I will answer your question!
If I cannot ...... I will request you hire me as your consultant.
I currently charge $199.00 an hour for my consultation services.
I always do my best to answer your questions in ONE paragraph.
The "initial coverage period (ICP)" for Part D, has a threshold of $4,020.00
When you hand in a prescription, the total amount of the prescription is applied towards the ICP.
If you have a Deductible, that is applied towards the ICP too.
When the total amount of your prescriptions reaches $4,020.00..... you will now enter a new phase called the "coverage gap."
In this stage.... you will now pay 25% of generic drugs....
and you will pay 25% of brand name drugs.
If you reach $5,018.75 you will enter the next stage, which is called....
The "Catastrophic Stage."
In the Catastrophic Stage, you will now pay a 5% co-insurance or $3.60 for Generic Drugs..... or....
$8.95 for Brand or non-preferred Drugs....
which ever is a greater amount.
You will remain in the Catastrophic Stage until your out-of-pocket spending reaches $6,350 or.....
when the ball drops on New Year's Eve!
I know prescription drugs can be very expensive!
There are programs available for those of you with lower incomes.
The program is called "Extra Help," or "Low Income Subsidy."
To apply for Extra Help, go to the social security website -
www.socialsecurity.gov/extrahelp
If your individual income is less than $1,562 a month, you would qualify for the LIS program.
If your income is more than $1,562 a month, but is less than $1,900 a month....APPLY!
You have nothing to lose! All they can say is No!
You can also appy for the "Medicare Savings Program" If you qualify, CMS will pay for your Medicare Part B Premium. Depending on your qualifications, CMS may pay your premium, deductible and co-insurance.
Apply for the Medicare Savings Program here:
https://www.medicare.gov/Contacts/#resources/msps
Thank you for listening to Medicare Nation!
If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!
If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use your help in putting the word out!
If you have any questions, send them to [email protected]
If I can answer it in one email - I will personally answer you!
If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.
Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!
Thanks again for listening!
Diane Daniels
Hey Medicare Nation!
www.TheMedicareNation.com
How Do I get treatment & prescriptions during a weather emergency?
Hurricane Dorian is moving up the East Coast of the U.S., and MILLIONS of people have evacuated the coastlines, to seek safety.
What happens if you get sick or you need to fill prescriptions while you’re away from home during a weather emergency?
Or….
What happens if you need to move into a Skilled Nursing Facility, but you haven’t fulfilled the “3 Day Prior Hospitalizaton” Rule….due to the weather emergency?
Let’s take a look at these questions for you.
After President Trump Declared Emergencies in Puerto Rico, Florida, Georgia & South Carolina….. Health & Human Services Secretary ….. Alex Azar….Declared Public Health Emergencies in those States. Secretary Azar also declared a “Blanket Waiver” for Hurricane Dorian.
What that means…… is some restrictions under Medicare are more “Flexible” during the Declaration.
For example…….
You evacuated your home in Savannah Georgia, to go stay with your relatives in Michigan. Prior to evacuating your home, you were receiving home health care for physical therapy…due to a sprained ankle.
If you are on Original Medicare, you can contact “Any” home health agency that accepts Medicare to re-start your physical therapy at your relative’s home. They should be able to contact Medicare to get copies of the orders you had for the Physical Therapy.
If you’re on a Medicare Advantage Plan, you will need to contact your Plan carrier…… advise them you evacuated from a Public Health Emergency area and that you need to “Resume” physical therapy at home ASAP. The plan should contact a home health care vendor in the area you’re temporarily staying in, to resume your physical therapy.
If you have a Medicare Specialist, call them! You WILL need their help in expediting the process. Remember…… MILLIONS of people have evacuated coastal areas! Don’t Delay!!! If you need to use your Medicare benefits…. CALL as soon as possible.
For Prescription Medications……let’s say in the stress of having to “evacuate,” you forgot all your prescriptions at home.
under a Medicare Advantage Plan, call your carrier & tell them what happened. You should be able to get a “Refill” under the “Emergency Waiver,” for most prescriptions. If you need an Extension for 60 – 90 days for your prescription, due to being out of the area, call your plan and ask them if they “offer” extended day prescriptions.
If you’re on an “opioid” prescription……… call your plan & advise them of your situation. Hopefully, you can get a refill…. for at least a day…. or two…… under the waiver, until you can be seen by a doctor in the area you’re temporarily staying at.
Your carrier will tell you which Pharmacy is “IN” network…. Where you’re staying. If there is NO pharmacy “In” Network where you’re staying, ask the carrier if they will “reimburse” you for the cost of the prescriptions.
You will need a receipt with the Pharmacy name, prescription name, and the price you paid for the prescription on the receipt to submit to your Medicare Advantage Carrier for reimbursement.
If you had Durable Medical Equipment …… Orthotics, Prosthetics, or Oxygen Supplies for example….. that was lost, destroyed, “irreparably damaged” ….. or otherwise rendered unusable…… you should be able to replace it from a vendor in the area you’re staying….. with the “flexibility” to WAIVE the replacement requirements that are normally in place.
If you are on a Medicare Advantage Plan, contact your carrier for assistance in getting a replacement…. And advise them the “Blanket Waiver” is in place.
They will assist you in finding a local vendor to “Replace” your equipment.
For those of you needing to stay at a “Skilled Nursing Facility,”Under “Normal” Circumstances…… if you or a loved one needed to enter a “Skilled Nursing Facility,” you would be required to have a “ 3 Day Prior Hospitalization” … prior to entering the Skilled Nursing Facility.
Under the “Blanket Waiver,” the 3 Day prior hospitalization is “waived,” so that you can enter the Skilled Nursing Facility without further delay.
This rule would be in effect “temporarily,” for those who are …… “ evacuated, transferred, or otherwise…. “dislocated” as a result of the emergency.
So….. if you “evacuated” your home in Puerto Rico, Florida, Georgia or South Carolina, due to Hurricane Dorian….. and let’s say you’re temporarily staying with relatives in Pennsylvania………and you need to enter a Skilled Nursing Facility……you would be able to enter the facility without the 3 day prior hospitalization.
If you are on a Medicare Advantage Plan, you must contact your carrier to assist you in determining which “Skilled Nursing Facilities” has room for you to be admitted into.
These are examples of how Medicare “requirements” are more flexible during a Public Health Emergency WITH a “Blanket Waiver.”
How long does the Blanket Waiver Last? Until Secretary AZAR signs an order stating the Public Health Emergency is over.
NOW….. let’s take a look at how FEMA affects enrollment into Medicare.
FEMA… which stands for the Federal Emergency Management Agency, also declared emergencies in Puerto Rico, Florida, Georgia, South Carolina AND the Virgin Islands (which are St. Croix, St. John, St. Thomas AND Water Island) ….., which creates a “Special Election Period” for Medicare Beneficiaries, who needed to enroll in a Medicare Plan during that time, but were unable to ….. due to the effects of Hurricane Dorian.
This means if you needed to enroll in Medicare, or into a Medicare Advantage Plan for September 1st…….. you will be given a Special Election Period to do so….
Under the Emergency “Weather Event.”
So….if you need to enroll into a Medicare Advantage Plan…..OR…. a Stand-Alone Prescription Drug Plan…. you can do so, most likely through the end of October…… or even November in South Carolina & Georgia, under the FEMA Emergency.
You can call Medicare at 800 – 633 – 4227 or your Medicare Specialist for more information.
If you feel you are overly “stressed” with all the information on TV & social media, about Hurricane Dorian…… #1 ….. STOP watching the news continuously! Listen to some music…. Read a book….. play a board game. Go out for a walk.
Continuously Watching the news about the weather is the worst thing you could do!
If you need to speak with someone, you can call the “Disaster Distress Helpline.”
Call 800 – 985 - 5990 to connect with a trained counselor, who can assist you with your distress.
You can even “TEXT” ….. TALKWITHUS type the letters all together and send it to…. 66746.
You can also go online to get more Public Health & Safety info by going to
https://www.phe.gov/Dorian
Finally….. if you would like to help those affected by Hurricane Dorian in the Bahamas….OR ….any of the other impacted States…..
Call your local TV Station or go onto their websites to find information on how to volunteer or donate supplies.
If you’d like to “donate” money to a cause…..
For Animals. Go to the Humane Society of the United States website…
HumaneSociety.org/Disaster-Relief
The Humane Society is evacuating animals form Animal Shelters across Florida and the other States. They have already helped transport almost 100 animals here in Florida, that they will place in “safe shelters,” with the hope of being put up for adoption.
If you’d like to contribute to a Humanitarian Charity….. or one that is specifically helping those in the Bahamas…… go to the Charity Navigator website & they have a list of highly ranked charities that are providing relief.
Go to http://charities.foundation/dorian
To donate to one of these funds.
That’s all for this special show and I wish everyone out there, in the path of Dorian…… that you & your loved ones are safe.
Till next time....
Have a Safe & Peaceful week!
Diane
Hey Medicare Nation!
www.TheMedicareNation.com
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TODAY.... I'm discussing NEW information released from CMS.
CMS Decision Summary Ambulatory Blood Pressure Monitoring Devices
July 2, 2019…..The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries.
What is hypertension (high blood pressure)?
The American Heart Association (AHA) defines blood pressure as…. a force that pushes blood through a network of arteries, veins and capillaries.
The blood pressure reading is the result of two forces:
Elevated blood pressure, or hypertension, leads to harm by causing tiny tears in the interior lining of the arteries and coronary vessels…..stimulating a local immune response in the endothelial cells within the atrial walls.
In these regions, the arterial intima retains apolipoprotein B, which attracts lipid-rich macrophages (foam cells).
These preatherotic lesions develop into atherosclerotic plaques which become increasingly fibrotic and can form fissures, hematomas, thrombi, and calcifications (Swirski and Nahrendorf, 2013). The end result is stiff, thickened arteries that narrow the flow of blood to organs and limbs….which both increases pressure on target organs and limits oxygenation of them.
There is also the risk of atherosclerotic plaque rupture, resulting in distal vascular obstruction and ischemia and infarction of end organs, such as stroke in the brain (U.S. Department of Health & Human Services, 2018).
CMS is lowering the blood pressure threshold for hypertension… from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria.
This will allow more patients to use ABPM and receive appropriate treatment if needed.
Ambulatory blood pressure monitoring (ABPM) is a diagnostic test… that allows for the identification of various types of high blood pressure.
ABPM devises are small… portable machines that are connected to a blood pressure cuff worn by patients…. that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities..including sleep.
The recording is interpreted by a physician or non-physician practitioner….and appropriate action is taken based on the findings.
Diagnosis and treatment of high blood pressure is important for the management of various conditions…. including cardiovascular disease and kidney disease.
Ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in Medicare beneficiaries is covered under the following circumstances:
ABPM devices must be:
CMS has covered ABPM since 2001 only for those patients with documented suspected white coat hypertension. On January 16, 2003, a technical correction for this National Coverage Determination was issued…. to clarify that a physician is required to perform the interpretation of the data obtained through ABPM…. but that there are no requirements regarding the setting in which the interpretation is performed.
CMS received a complete, formal request for a reconsideration of the national coverage determination from the American Heart Association and American Medical Association.
You can view the formal request letter on the tracking sheet on the CMS website.
Benefit Category
Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.
ABPM may be considered to be within the benefits described under sections:
other diagnostic tests (§1861(s)(3).
Medicare regulations state in part, that "…diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem." (42 CFR 410.32(a))
UNDER APPENDIX C
(Current Section 20.19 of the National Coverage Determination Manual)
Item/Service Description
Ambulatory blood pressure monitoring (ABPM) involves the use of a non-invasive device which is used to measure blood pressure in 24-hour cycles. These 24-hour measurements are stored in the device and are later interpreted by the physician.
Indications and Limitations of Coverage
ABPM must be performed for at least 24 hours to meet coverage criteria.
ABPM is only covered for those patients with suspected white coat hypertension.
Suspected white coat hypertension is defined as:
Office blood pressure >140/90 on at least three separate clinic/office visits with two separate measurements made at each visit;
In the rare circumstance that ABPM needs to be performed more than once
in a patient, the qualifying criteria described above must be met for each subsequent ABPM test.
For those patients that undergo ABPM and have an ambulatory blood pressure of <135/85 with no evidence of end-organ damage, it is likely that their cardiovascular risk is similar to that of normotensives. Patients should be followed over time.
Patients for which ABPM demonstrates a blood pressure of >135/85 may be at increased cardiovascular risk, and a physician may wish to consider antihypertensive therapy
Resources: Medicare.gov Website
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Diane Daniels
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www.TheMedicareNation.com
Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200!
CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.
From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information.
In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing.
Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services.
Enrollees were affected in the following area:
Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY.
Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs.
CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage.
Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost.
In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0, you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.
Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you.
If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation.
If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240.
You can also make a complaint to Medicare directly by calling 800-633-4227.
If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240.
If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can :
1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan
or
2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/
when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads -
Find Your Local SHIP
"Click" on that ORANGE buton and a list will come up of all 50 States.
"Click" on the State where you reside, to contact your local SHIP center.
If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either:
[email protected]
or
call me at 855-855-7266
If I can answer your question in ONE paragraph in an email, I will directly answer your question!
If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.
I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country!
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Diane Daniels
The podcast currently has 98 episodes available.