Will my Medicare Part B premium increase in 2011?
Most Medicare beneficiaries will continue to pay the same $96.40 or $110.50 Part B premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2011.
For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ
titled: 2011 Part B Premium Amounts for Persons with Higher
Income Levels. In 2011:
New Part B beneficiaries will pay $115.40 (because they did not have the premium withheld from their Social Security benefit in the previous year).
• Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $115.40.
• Higher-income beneficiares pay $115.40 plus an additional amount, based on the income-related monthly adjustment amount (IRMAA).
Monday, March 28, 2011
Sunday, March 27, 2011
Medicare part A & part B premium and coinsurance rates
What are the Medicare premiums and coinsurance rates for 2011
The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2011:
Medicare Premiums for 2011:
Part A: (Hospital Insurance) Premium
• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered
employment.
• The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011.
For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2011?"
For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ titled: "2011 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2010:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
• A total of $1,132 for a hospital stay of 1-60 days.
• $283 per day for days 61-90 of a hospital stay.
• $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
• $141.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
• $162.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $162.00 deductible.)
The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2011:
Medicare Premiums for 2011:
Part A: (Hospital Insurance) Premium
• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered
employment.
• The Part A premium is $450.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011.
For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2011?"
For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ titled: "2011 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2010:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
• A total of $1,132 for a hospital stay of 1-60 days.
• $283 per day for days 61-90 of a hospital stay.
• $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
• $141.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
• $162.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $162.00 deductible.)
Friday, March 25, 2011
Obtaining EOB or RA through IVR system
Ordering Remittance Advice (RA) Through the Claim Status Option of the Interactive
Voice Response (IVR) - Issue Identified
DME MAC Jurisdiction A has identified an error of not producing Remittance Advice
(RA) requests via the Claim Status method (Option 1) of the IVR. When requesting
a copy of an RA via option 1 of the Claim Status menu, the system is sending a
Medicare Summary Notice (MSN) to the beneficiary instead of issuing an RA to the
supplier. The Financial menu, option 5, may also be used to request an RA through
the IVR.
Until further notice, all suppliers should use the Financial menu, option 5, when
requesting a copy of the RA.
Voice Response (IVR) - Issue Identified
DME MAC Jurisdiction A has identified an error of not producing Remittance Advice
(RA) requests via the Claim Status method (Option 1) of the IVR. When requesting
a copy of an RA via option 1 of the Claim Status menu, the system is sending a
Medicare Summary Notice (MSN) to the beneficiary instead of issuing an RA to the
supplier. The Financial menu, option 5, may also be used to request an RA through
the IVR.
Until further notice, all suppliers should use the Financial menu, option 5, when
requesting a copy of the RA.
Tuesday, March 22, 2011
Eligibility verification throught Medicare IVR - Information required
Eligibility Options Available via the Jurisdiction A DME MAC IVR
The DME MAC A Call Center has seen an increase of calls due to eligibility denials
for a Medicare beneficiary. Some of the common ANSI denials associated with eligibility
include, but aren't limited to:
* ANSI 22: Payment adjusted because this care may be covered by another payer per
coordination of benefits.
* ANSI 13: The date of death precedes the date of service.
* ANSI 24: Payment for charges adjusted. Charges are covered under a capitation
agreement/managed care plan.
* ANSI B15 with remark code N70: This service/procedure requires that a qualifying
service/procedure be received and covered. The qualifying other service/procedure
has not been received/adjudicated. Consolidated billing and payment applies.
* ANSI 45 with remark code N88: Charge exceeds fee schedule/maximum allowable or
contracted/legislated fee arrangement. This payment is being made conditionally.
A Home Heath Agency episode of care notice has been filed for this patient. When
a patient is treated under a HHA episode of care, consolidated billing requires
that certain therapy services and supplies, such as this, be included in the HHA's
payment. This payment will need to be recouped from you if we establish that the
patient is concurrently receiving treatment under a HHA episode of care.
* ANSI B9: Patient is enrolled in a Hospice
* ANSI 109 with remark code M2: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. Not paid separately when the
patient is an inpatient.
* ANSI 109 with remark code MA101: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. A Skilled Nursing Facility
(SNF) is responsible for payment of outside providers who furnish these services/supplies
to residents.
Note:The ANSI denials listed above typically have a CO (contractual obligation)
or PR (patient responsibility) reported with the code.
The Centers for Medicare & Medicaid Services (CMS) requires suppliers to utilize
self-service options, such as the interactive voice response (IVR) system. When
calling the DME MAC A Call Center and asking for eligibility and/or explanation
of a denial, you will be directed back to the IVR.
The IVR, 866-419-9458, is available for the supplier community Monday -Friday, 6:00
a.m. - 7:00 p.m. EST and Saturday, 6:00 a.m. - 3:00 p.m. EST
In order to obtain eligibility through the IVR, suppliers will need to select option
2. After selecting option 2, the IVR will request and collect the following elements:
* NPI
* PTAN (ten-digit supplier number)
* Last five digits of the Tax Identification Number (TIN)
* Beneficiary Medicare number
* Beneficiary first and last name (last name and first initial if using touch-tone)
* Beneficiary date of birth
* Date of service
Once the authentication elements have been verified, the IVR will supply the following
information:
* Part A and Part B effective/termination dates
* Current/prior year Part B deductible amounts
* Medicare secondary payer (MSP) type, insurer name, and effective/termination dates
* Medicare advantage plan number, name, address, telephone number, and effective/termination
dates
* Home health name, address, and effective/termination dates
* Hospice name, address, and effective/termination dates
* Date of death
* Corrected Medicare number
Effective January 14, 2011, a new enhancement was added to the Claims option (option
1) on the IVR. Suppliers are able to select Claim Details (touch tone 4) in order
to obtain admission/discharge dates and patient status date if the claim denied
due to Home Health, Hospice, Inpatient Stay, or Skilled Nursing Facility. Suppliers
will also be able to obtain the name and address of the facility.
The DME MAC A Call Center has seen an increase of calls due to eligibility denials
for a Medicare beneficiary. Some of the common ANSI denials associated with eligibility
include, but aren't limited to:
* ANSI 22: Payment adjusted because this care may be covered by another payer per
coordination of benefits.
* ANSI 13: The date of death precedes the date of service.
* ANSI 24: Payment for charges adjusted. Charges are covered under a capitation
agreement/managed care plan.
* ANSI B15 with remark code N70: This service/procedure requires that a qualifying
service/procedure be received and covered. The qualifying other service/procedure
has not been received/adjudicated. Consolidated billing and payment applies.
* ANSI 45 with remark code N88: Charge exceeds fee schedule/maximum allowable or
contracted/legislated fee arrangement. This payment is being made conditionally.
A Home Heath Agency episode of care notice has been filed for this patient. When
a patient is treated under a HHA episode of care, consolidated billing requires
that certain therapy services and supplies, such as this, be included in the HHA's
payment. This payment will need to be recouped from you if we establish that the
patient is concurrently receiving treatment under a HHA episode of care.
* ANSI B9: Patient is enrolled in a Hospice
* ANSI 109 with remark code M2: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. Not paid separately when the
patient is an inpatient.
* ANSI 109 with remark code MA101: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. A Skilled Nursing Facility
(SNF) is responsible for payment of outside providers who furnish these services/supplies
to residents.
Note:The ANSI denials listed above typically have a CO (contractual obligation)
or PR (patient responsibility) reported with the code.
The Centers for Medicare & Medicaid Services (CMS) requires suppliers to utilize
self-service options, such as the interactive voice response (IVR) system. When
calling the DME MAC A Call Center and asking for eligibility and/or explanation
of a denial, you will be directed back to the IVR.
The IVR, 866-419-9458, is available for the supplier community Monday -Friday, 6:00
a.m. - 7:00 p.m. EST and Saturday, 6:00 a.m. - 3:00 p.m. EST
In order to obtain eligibility through the IVR, suppliers will need to select option
2. After selecting option 2, the IVR will request and collect the following elements:
* NPI
* PTAN (ten-digit supplier number)
* Last five digits of the Tax Identification Number (TIN)
* Beneficiary Medicare number
* Beneficiary first and last name (last name and first initial if using touch-tone)
* Beneficiary date of birth
* Date of service
Once the authentication elements have been verified, the IVR will supply the following
information:
* Part A and Part B effective/termination dates
* Current/prior year Part B deductible amounts
* Medicare secondary payer (MSP) type, insurer name, and effective/termination dates
* Medicare advantage plan number, name, address, telephone number, and effective/termination
dates
* Home health name, address, and effective/termination dates
* Hospice name, address, and effective/termination dates
* Date of death
* Corrected Medicare number
Effective January 14, 2011, a new enhancement was added to the Claims option (option
1) on the IVR. Suppliers are able to select Claim Details (touch tone 4) in order
to obtain admission/discharge dates and patient status date if the claim denied
due to Home Health, Hospice, Inpatient Stay, or Skilled Nursing Facility. Suppliers
will also be able to obtain the name and address of the facility.
Sunday, March 20, 2011
Upgrade modifiers and resubmit the claim
Resubmitting Claims with Upgrade Modifiers - Effective 02/04/2011
Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) issued bulletin articles regarding the use of upgrade modifiers in conjunction with HCPCS codes subject to the elimination of least costly alternative (LCA). For certain items that were previously subject to LCA, suppliers will now receive a not reasonable and necessary denial. The article indicated that further instructions would be forthcoming concerning the options that a supplier has if a claim for an item previously subject to LCA is submitted without upgrade modifiers, is subsequently denied as not reasonable and necessary and the supplier decides that it would like to utilize the upgrade modifiers.
For items that were previously subject to LCA, suppliers have the option of resubmitting the claim using the upgrade modifiers and the code for the covered medically necessary item rather than exercising the option of Appeals. For example, a supplier submits a claim after February 04, 2011 for code E0265 (fully electric hospital bed) and the claim is denied as not reasonable and necessary. That claim may be resubmitted with code E0265 and the appropriate modifiers on Line 1 and code E0260 and the appropriate modifiers on Line 2. Resubmitting the claim in this fashion will not result in a conflict with the original code E0265 claim and subsequent duplicate claim denial.
These resubmission instructions apply only to items previously subject to LCA payment policy that now receive not reasonable and necessary denials. Other items receiving reasonable and necessary denials must follow the usual redeterminations process.
Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) issued bulletin articles regarding the use of upgrade modifiers in conjunction with HCPCS codes subject to the elimination of least costly alternative (LCA). For certain items that were previously subject to LCA, suppliers will now receive a not reasonable and necessary denial. The article indicated that further instructions would be forthcoming concerning the options that a supplier has if a claim for an item previously subject to LCA is submitted without upgrade modifiers, is subsequently denied as not reasonable and necessary and the supplier decides that it would like to utilize the upgrade modifiers.
For items that were previously subject to LCA, suppliers have the option of resubmitting the claim using the upgrade modifiers and the code for the covered medically necessary item rather than exercising the option of Appeals. For example, a supplier submits a claim after February 04, 2011 for code E0265 (fully electric hospital bed) and the claim is denied as not reasonable and necessary. That claim may be resubmitted with code E0265 and the appropriate modifiers on Line 1 and code E0260 and the appropriate modifiers on Line 2. Resubmitting the claim in this fashion will not result in a conflict with the original code E0265 claim and subsequent duplicate claim denial.
These resubmission instructions apply only to items previously subject to LCA payment policy that now receive not reasonable and necessary denials. Other items receiving reasonable and necessary denials must follow the usual redeterminations process.
Thursday, March 17, 2011
Medicare benefits for Bone Mass Measurements
Bone Mass Measurements
Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). People are at risk for fractures because of osteoporosis. Osteoporosis is a disease in which your bones become weak. In general, the lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong.
How often is it covered?
Once every 24 months (more often if medically necessary)
For whom?
All people with Medicare who are at risk for osteoporosis.
Your costs if you have Original Medicare
Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.
Are you at risk for osteoporosis?
Your risk for osteoporosis increases if you…
are age 50 or older
are a woman
have a family history of broken bones
have a personal history of broken bones
are White or Asian
are small-boned
have low body weight (less than about 127 pounds)
smoke or drink a lot
have a low-calcium diet
Medicare covers bone mass measurements to determine whether you are at risk for a fracture (broken bone). People are at risk for fractures because of osteoporosis. Osteoporosis is a disease in which your bones become weak. In general, the lower your bone density, the higher your risk is for a fracture. Bone mass measurement test results will help you and your doctor choose the best way to keep your bones strong.
How often is it covered?
Once every 24 months (more often if medically necessary)
For whom?
All people with Medicare who are at risk for osteoporosis.
Your costs if you have Original Medicare
Before January 1, 2011, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Starting January 1, 2011, you pay nothing for this test if the doctor accepts assignment.
Are you at risk for osteoporosis?
Your risk for osteoporosis increases if you…
are age 50 or older
are a woman
have a family history of broken bones
have a personal history of broken bones
are White or Asian
are small-boned
have low body weight (less than about 127 pounds)
smoke or drink a lot
have a low-calcium diet
Tuesday, March 15, 2011
Medicare benefits for Abdominal Aortic Aneurysm (AAA) Screening
Abdominal Aortic Aneurysm (AAA) Screening
Abdominal Aortic Aneurysm (AAA) is a vascular disease with life-threatening implications. If you have a family history of abdominal aortic aneurysm or have smoked at least 100 cigarettes in your lifetime, you are considered at risk.
How often is it covered?
Medicare covers this one-time screening ultrasound if you get a referral for it as a result of your "Welcome to Medicare" physical exam. You must receive the physical exam and the screening ultrasound referral (not the ultrasound exam itself) within the first twelve months you have Medicare Part B.
For whom?
People with Medicare who meet the following criteria are eligible:
He or she must get a referral for the AAA ultrasound screening from a physician or other qualified non-physician practitioner as a result of their "Welcome to Medicare" physical exam.
He or she has never had an AAA ultrasound screening paid for by Medicare.
The person with Medicare has at least one of the following risk factors a family history of abdominal aortic aneurysm is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
Certain other risk factors may apply. Talk to your doctor to find out more.
Your costs in the Original Medicare Plan?
For the AAA screening ultrasound, you pay 20% of the Medicare-approved amount with no Part B deductible.
Abdominal Aortic Aneurysm (AAA) is a vascular disease with life-threatening implications. If you have a family history of abdominal aortic aneurysm or have smoked at least 100 cigarettes in your lifetime, you are considered at risk.
How often is it covered?
Medicare covers this one-time screening ultrasound if you get a referral for it as a result of your "Welcome to Medicare" physical exam. You must receive the physical exam and the screening ultrasound referral (not the ultrasound exam itself) within the first twelve months you have Medicare Part B.
For whom?
People with Medicare who meet the following criteria are eligible:
He or she must get a referral for the AAA ultrasound screening from a physician or other qualified non-physician practitioner as a result of their "Welcome to Medicare" physical exam.
He or she has never had an AAA ultrasound screening paid for by Medicare.
The person with Medicare has at least one of the following risk factors a family history of abdominal aortic aneurysm is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime
Certain other risk factors may apply. Talk to your doctor to find out more.
Your costs in the Original Medicare Plan?
For the AAA screening ultrasound, you pay 20% of the Medicare-approved amount with no Part B deductible.
Sunday, March 13, 2011
Who has to take Flu vaccine?
CDC recommends everyone 6 months and older get a flu vaccine
The Centers for Disease Control and Prevention (CDC) has set aside the week of December 5-11, 2010 to observe this season's National Influenza Vaccination Week. The week-long emphasis on flu vaccination was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. National Influenza Vaccination Week provides an opportunity for public health professionals, health care professionals, health advocates, communities, and families from across the country to work together to promote flu vaccination before the traditional winter peak in flu activity.
With three strains of flu expected to circulate in the 2010-2011 season, it is important that everyone 6 months of age and older get vaccinated if they haven't already done so, to protect themselves and their loved ones from flu. The three flu strains identified by the CDCs' Advisory Committee on Immunization Practices are an A/H3N2 strain, a B strain and the 2009 H1N1 pandemic strain. This year's flu vaccine provides protection against all three strains and approximately 160 million doses of the vaccine have already been distributed nationwide.
The universal flu vaccine recommendation, which encourages everyone 6 months of age and older to be vaccinated, took effect this flu season, "The new vaccination recommendation shows the importance of preventing the flu in everyone," says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC's Director of the National Center for Immunization and Respiratory Diseases. "People who do not get vaccinated are taking two risks: first, they are placing themselves at risk for the flu, including a potentially long and serious illness, and second, if they get sick, they are also placing their close contacts at risk for influenza."
"The bottom line is, anyone—even healthy people—can get sick from the flu," said Assistant Secretary for Health Howard K. Koh, M.D., M.P.H. "Lead the way to better health for all by getting your flu shot."
One of the many goals for NIVW is to engage at-risk audiences who are not yet vaccinated, hesitant about vaccination, or unsure about where to get vaccinated. Each day of National Influenza Vaccination Week is designated to highlight the importance for certain groups such as families, older adults, and people with high risk conditions like diabetes, asthma and heart problems, to get vaccinated. The kickoff day, Sunday, December 5th, will emphasize the importance of the universal vaccination recommendation, because everyone needs to be protected from flu.
The Centers for Disease Control and Prevention (CDC) has set aside the week of December 5-11, 2010 to observe this season's National Influenza Vaccination Week. The week-long emphasis on flu vaccination was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. National Influenza Vaccination Week provides an opportunity for public health professionals, health care professionals, health advocates, communities, and families from across the country to work together to promote flu vaccination before the traditional winter peak in flu activity.
With three strains of flu expected to circulate in the 2010-2011 season, it is important that everyone 6 months of age and older get vaccinated if they haven't already done so, to protect themselves and their loved ones from flu. The three flu strains identified by the CDCs' Advisory Committee on Immunization Practices are an A/H3N2 strain, a B strain and the 2009 H1N1 pandemic strain. This year's flu vaccine provides protection against all three strains and approximately 160 million doses of the vaccine have already been distributed nationwide.
The universal flu vaccine recommendation, which encourages everyone 6 months of age and older to be vaccinated, took effect this flu season, "The new vaccination recommendation shows the importance of preventing the flu in everyone," says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC's Director of the National Center for Immunization and Respiratory Diseases. "People who do not get vaccinated are taking two risks: first, they are placing themselves at risk for the flu, including a potentially long and serious illness, and second, if they get sick, they are also placing their close contacts at risk for influenza."
"The bottom line is, anyone—even healthy people—can get sick from the flu," said Assistant Secretary for Health Howard K. Koh, M.D., M.P.H. "Lead the way to better health for all by getting your flu shot."
One of the many goals for NIVW is to engage at-risk audiences who are not yet vaccinated, hesitant about vaccination, or unsure about where to get vaccinated. Each day of National Influenza Vaccination Week is designated to highlight the importance for certain groups such as families, older adults, and people with high risk conditions like diabetes, asthma and heart problems, to get vaccinated. The kickoff day, Sunday, December 5th, will emphasize the importance of the universal vaccination recommendation, because everyone needs to be protected from flu.
Friday, March 11, 2011
Medicare and Flu - Influenza - all information
Flu Information
What is the Flu?
Influenza, also called the "flu," is a respiratory infection that's highly contagious. If you have flu symptoms, try to avoid contact with others to prevent spreading the infection.
How do I know if I have the flu?
If you get the flu, you may have a fever, chills, headache, dry cough, runny or stuffy nose, sore throat, and muscle aches. Unlike the common cold, the flu can make you feel very tired or exhausted for several days, a week, or more. Most adults with the flu don't get an upset stomach, but children and some adults might have nausea, vomiting, and diarrhea. What people often call "stomach flu" is not influenza.
How can I get the flu?
The flu spreads easily from person to person especially when someone with the flu coughs or sneezes. A person with the flu usually experiences symptoms within 2 to 4 days, and remains contagious for another 3 to 4 days after symptoms appear.
Will Medicare pay for a flu shot?
Medicare covers the flu shot once per flu season. With Part B, you pay nothing for the flu shot if the doctor or other health care provider accepts assignment for giving the shot.
When should I get a flu shot?
Flu shots are available starting in the fall, for the fall and winter flu season. The Centers for Disease Control and Prevention (CDC) recommends you get the flu shot as soon as it is available in your area.
What is the Flu?
Influenza, also called the "flu," is a respiratory infection that's highly contagious. If you have flu symptoms, try to avoid contact with others to prevent spreading the infection.
How do I know if I have the flu?
If you get the flu, you may have a fever, chills, headache, dry cough, runny or stuffy nose, sore throat, and muscle aches. Unlike the common cold, the flu can make you feel very tired or exhausted for several days, a week, or more. Most adults with the flu don't get an upset stomach, but children and some adults might have nausea, vomiting, and diarrhea. What people often call "stomach flu" is not influenza.
How can I get the flu?
The flu spreads easily from person to person especially when someone with the flu coughs or sneezes. A person with the flu usually experiences symptoms within 2 to 4 days, and remains contagious for another 3 to 4 days after symptoms appear.
Will Medicare pay for a flu shot?
Medicare covers the flu shot once per flu season. With Part B, you pay nothing for the flu shot if the doctor or other health care provider accepts assignment for giving the shot.
When should I get a flu shot?
Flu shots are available starting in the fall, for the fall and winter flu season. The Centers for Disease Control and Prevention (CDC) recommends you get the flu shot as soon as it is available in your area.
Wednesday, March 9, 2011
Medicare IVR Main Menu user Guide
DME MAC A IVR User Guide - Main Menu Options
Main Menu Options
The main menu and subsequent menus can be navigated by using your voice or using touch-tone on the
telephone keypad. You can also use touch-tone entry for Provider Transaction Access Numbers (PTANs),
Medicare numbers, tax identification numbers (TINs), dates of service, dates of birth, HCPCS codes, and
beneficiary names. Touch-tone instructions and examples are also included in this guide.
Note: The 10-digit legacy supplier number is now being referred to as the PTAN.
Select the main menu option for a complete list of elements required from the caller and the information that
the caller will hear back from the IVR.
Voice Touch-Tone Entry
Claims 1
Eligibility 2
CMN Status 3
Appeals 4
Financial 5
Pricing 6
Same or Similar 7
Questions 8
Description of Main Menu Options *
Main Menu Options
The main menu and subsequent menus can be navigated by using your voice or using touch-tone on the
telephone keypad. You can also use touch-tone entry for Provider Transaction Access Numbers (PTANs),
Medicare numbers, tax identification numbers (TINs), dates of service, dates of birth, HCPCS codes, and
beneficiary names. Touch-tone instructions and examples are also included in this guide.
Note: The 10-digit legacy supplier number is now being referred to as the PTAN.
Select the main menu option for a complete list of elements required from the caller and the information that
the caller will hear back from the IVR.
Voice Touch-Tone Entry
Claims 1
Eligibility 2
CMN Status 3
Appeals 4
Financial 5
Pricing 6
Same or Similar 7
Questions 8
Description of Main Menu Options *
Monday, March 7, 2011
Medicare update on influenza vaccine - CPT Q2035, Q2036, Q2037, Q2038
We would like to inform that effective from the dates of services Jan 1, 2011 CPT 90658 (Influenza vaccine) would not be paid by Medicare and replaced with the below mentioned codes.
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified
Tuesday, March 1, 2011
Medicare home healthcare coverage and solution for Medicare denial
Does Medicare cover home health care?
Medicare will cover home health care if
(a) your care requires intermittent or part-time skilled services, physical therapy or speech
therapy;
(b) you are confined to your home and;
(c) your doctor says you need home health care.
Once it has been determined that you are eligible for home health coverage, you can
begin to receive home health aide services in addition to skilled care. These include
(a) household services essential to your health care at home;
(b) help with medications that you would normally take yourself;
(c) simple procedures that are an extension of therapy services; and
(d) personal care including help with daily activities.
What should I look for if claim denied by Medicare?
If your Medicare coverage is restricted incorrectly, you risk losing your home health care
completely, or receiving less care than you actually need. If you are denied coverage for any of
these reasons, be suspicious and challenge the denial:
(a) Duration denials: There are no time limits on how long you can receive home health
services. If you have a chronic condition, you have a good chance of getting the coverage you need.
As long as you need skilled care at least once every 2 months, you are entitled to home health care
coverage.
During this time, you are not required to improve or reach certain goals established by your plan
of care. It is enough if your care prevents or slows your health from getting worse, or helps you stay
at your current level of functioning. This is particularly important if you are receiving skilled
rehabilitation.
(b) “Not medically reasonable” denials: Medicare intermediaries often use their own
judgment to decide if certain skilled care is medically reasonable. Your own doctor, and not an
insurance company, should decide what care you need.
The Medicare evaluator or "intermediary" should not substitute its judgment for your
doctor’s in determining what care is needed. Medicare highly values and will usually accept the
opinion of the treating physician in determining the reasonableness and need for the health
services furnished by providers.
(c) “Not homebound” denials: Medicare sometimes improperly denies coverage to
individuals who are homebound and unable to leave home to obtain necessary care. If you
cannot leave your home without help from an individual or supportive device (such as crutches
or a wheelchair), you are considered homebound.
This is also true if it is not medically advisable for you to leave your home without
assistance. You do not need to be bedridden, but should be normally unable to leave home. In
certain circumstances, you can still be considered homebound even if you attend an adult day
care program outside your home.
(d) "Family members can provide the needed care" denials: Your family is under no
obligation to give you the kind of care provided by home health agencies. Likewise, you do not
have to accept the services of a family member. In some cases, having a family member provide
the care you need is not only inappropriate but also dangerous.
(e) "No improvement" denials: Medicare coverage is available even if you are not going to
improve medically and you need skilled care to prevent or delay further deterioration or preserve
your current capabilities.
To get coverage for care that maintains your current capabilities, it should be described in terms
of reaching a goal, such as the goal of maintaining or preventing further deterioration.
(f) Supervision by a skilled practitioner: To qualify for Medicare coverage based on
supervision by a skilled practitioner, all that is required is that a registered nurse, licensed practical
nurse, physical or occupational therapist, speech pathologist or audiologist generally supervise
skilled nursing and rehabilitation services.
A supervisor does not have to be physically present or on the premises when services are
performed.
(g) Coordinating a plan of care: Medicare regulations say that your overall condition must be
considered and that skilled personnel may be necessary to perform and coordinate a series of tasks
that, taken individually, would not require a skilled professional.
(h) Observation and assessment as a skilled service: Observation and assessment are
considered to be skilled services when the skills of a technical or professional person are
required to identify and evaluate your need for additional medical procedures.
For example, a patient with congestive heart failure may need continuous close
observation to detect signs of deterioration, abnormal fluid balance or a bad reaction to
medications.
Likewise, patients discharged from a hospital while in a complicated and unstable
condition after surgery may need continued skilled monitoring to watch for post-operative
complications.
(i) Management and evaluation of care plan: Management and evaluation is a skilled
service when the skills of a technician or professional are periodically required to evaluate and
manage the home health aide services you receive. In other words, the skilled professional
oversees the unskilled services to make sure that they are effective.
For example, a nurse’s management and evaluation skills would be needed to monitor the
diet, fluid intake and other health-related needs of an Alzheimer’s patient. The services could be
provided by unskilled home health aides with the skilled nurse managing the services and
periodically evaluating the patient.
Medicare will cover home health care if
(a) your care requires intermittent or part-time skilled services, physical therapy or speech
therapy;
(b) you are confined to your home and;
(c) your doctor says you need home health care.
Once it has been determined that you are eligible for home health coverage, you can
begin to receive home health aide services in addition to skilled care. These include
(a) household services essential to your health care at home;
(b) help with medications that you would normally take yourself;
(c) simple procedures that are an extension of therapy services; and
(d) personal care including help with daily activities.
What should I look for if claim denied by Medicare?
If your Medicare coverage is restricted incorrectly, you risk losing your home health care
completely, or receiving less care than you actually need. If you are denied coverage for any of
these reasons, be suspicious and challenge the denial:
(a) Duration denials: There are no time limits on how long you can receive home health
services. If you have a chronic condition, you have a good chance of getting the coverage you need.
As long as you need skilled care at least once every 2 months, you are entitled to home health care
coverage.
During this time, you are not required to improve or reach certain goals established by your plan
of care. It is enough if your care prevents or slows your health from getting worse, or helps you stay
at your current level of functioning. This is particularly important if you are receiving skilled
rehabilitation.
(b) “Not medically reasonable” denials: Medicare intermediaries often use their own
judgment to decide if certain skilled care is medically reasonable. Your own doctor, and not an
insurance company, should decide what care you need.
The Medicare evaluator or "intermediary" should not substitute its judgment for your
doctor’s in determining what care is needed. Medicare highly values and will usually accept the
opinion of the treating physician in determining the reasonableness and need for the health
services furnished by providers.
(c) “Not homebound” denials: Medicare sometimes improperly denies coverage to
individuals who are homebound and unable to leave home to obtain necessary care. If you
cannot leave your home without help from an individual or supportive device (such as crutches
or a wheelchair), you are considered homebound.
This is also true if it is not medically advisable for you to leave your home without
assistance. You do not need to be bedridden, but should be normally unable to leave home. In
certain circumstances, you can still be considered homebound even if you attend an adult day
care program outside your home.
(d) "Family members can provide the needed care" denials: Your family is under no
obligation to give you the kind of care provided by home health agencies. Likewise, you do not
have to accept the services of a family member. In some cases, having a family member provide
the care you need is not only inappropriate but also dangerous.
(e) "No improvement" denials: Medicare coverage is available even if you are not going to
improve medically and you need skilled care to prevent or delay further deterioration or preserve
your current capabilities.
To get coverage for care that maintains your current capabilities, it should be described in terms
of reaching a goal, such as the goal of maintaining or preventing further deterioration.
(f) Supervision by a skilled practitioner: To qualify for Medicare coverage based on
supervision by a skilled practitioner, all that is required is that a registered nurse, licensed practical
nurse, physical or occupational therapist, speech pathologist or audiologist generally supervise
skilled nursing and rehabilitation services.
A supervisor does not have to be physically present or on the premises when services are
performed.
(g) Coordinating a plan of care: Medicare regulations say that your overall condition must be
considered and that skilled personnel may be necessary to perform and coordinate a series of tasks
that, taken individually, would not require a skilled professional.
(h) Observation and assessment as a skilled service: Observation and assessment are
considered to be skilled services when the skills of a technical or professional person are
required to identify and evaluate your need for additional medical procedures.
For example, a patient with congestive heart failure may need continuous close
observation to detect signs of deterioration, abnormal fluid balance or a bad reaction to
medications.
Likewise, patients discharged from a hospital while in a complicated and unstable
condition after surgery may need continued skilled monitoring to watch for post-operative
complications.
(i) Management and evaluation of care plan: Management and evaluation is a skilled
service when the skills of a technician or professional are periodically required to evaluate and
manage the home health aide services you receive. In other words, the skilled professional
oversees the unskilled services to make sure that they are effective.
For example, a nurse’s management and evaluation skills would be needed to monitor the
diet, fluid intake and other health-related needs of an Alzheimer’s patient. The services could be
provided by unskilled home health aides with the skilled nurse managing the services and
periodically evaluating the patient.
Medicare physician fee schedule - Quick overview
