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Breaking News: Individuals May Opt-Out of Insurance Program in Health Care Reform

August 24, 2012 1 comment

Breaking News regarding health care reform.

Individuals are not  required to participate in health insurance programs under health care reform. Section 1555 of P.L. 111-148 (Patient Protection and Affordable Care Act) allows for individuals not to be required to participate in any health insurance program. They will not be penalized if they do not participate. Language from the provision is listed below and can also be read HERE

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Section 1555 – Freedom Not To Participate in Health Insurance Programs
No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.
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Stay tuned for more on this Breaking News story regarding health care reform. For more information on health care reform, please click  HERE

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The Truth About Ron Wyden’s Medicare Plan

August 21, 2012 1 comment

What You Should Know About Ron Wyden‘s Medicare Plan

On August 11th, GOP Presidential Candidate Governor Mitt Romney introduced Representative Paul Ryan as his choice for Vice President. Once this was announced, media outlets “freaked out” over the Medicare plan Senator Ron Wyden (D-OR) wrote with Representative Paul Ryan (R-WI, Chairman of U.S. House Budget Committee). The plan is a bipartisan plan officially called “The Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future” and it is a roadmap for how to strengthen and fix or failing Medicare system. Senator Wyden and Representative Paul focus their plan on choice, affordability, and protecting seniors. You can read more about the plan by clicking HERE

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Choice

Starting in 2022, a new Medicare program will begin offering seniors a choice among private plans and the traditional Medicare plan – much like plans Members of Congress have. Any senior at or above age 55 today will see no changes in their Medicare. (Page 2)

Affordability

Coverage will be guaranteed through a new “premium support” system that encourages plans to provide high-quality care more efficiently. Private plans will compete directly with traditional Medicare based on their ability to provide quality coverage at an affordable lower cost. Low-income seniors shopping for coverage would be offered the same range of high-quality options offered to all other seniors. They would be guaranteed the ability to choose a traditional fee-for- service Medicare plan, or they could choose a private plan on the Medicare Exchange with a fully- funded account from which to pay premiums, co-pays and other out-of-pocket costs. (Page 2,9)

Protecting Seniors
To ensure ample protection from scam-artists and bad actors, the program will not only require insurance coverage protections such as guaranteed issue and risk adjustment, but it will also require the Centers for Medicare and Medicaid Services (CMS) to actively review marketing practices and benefit adequacy. Plans that fail to comply with established standards of participation would have their contracts terminated. Building upon Medicare’s current marketing rules, all plans would also be required to have their marketing materials approved annually by CMS. (Page 2, 10)
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Above are the facts of Senator Ron Wyden’s Medicare Plan. Keep in mind that is only a proposal and it can not become reality without passing Congress first. You can read more about the plan by clicking HERE

What Every Gynecologist Should Know About Health Care Reform

August 20, 2012 1 comment

Below is what every  Gynecologist should know about health care reform.

The provisions listed below will have a direct impact on women’s healthcare and gynecologists need to take the time to familiarize themselves with the new regulations.
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Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition (i.e. pregnancy) exclusion with respect to such plan or coverage.

Section 2301 – Coverage for Birthing Centers
A State shall provide separate payments to providers administering prenatal labor and delivery or postpartum care in a freestanding birth center (as defined in subparagraph (B)), such as nurse midwives and other providers of services such as birth attendants recognized under State law, as determined appropriate by the Secretary. For purposes of the preceding sentence, the term `birth attendant’ means an individual who is recognized or registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a birth attendant.

Section 3111 – Payment for Bone Density Tests
For dual-energy x-ray absorptiometry services (bone density, identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product.

Section 4104 – Elimination of Co-Pay
Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings.

Section 4107 – Coverage for Tobacco Cessation Services for Pregnant Women
Requiring Coverage of Counseling and Pharmacotherapy for Cessation of Tobacco Use by Pregnant Women- Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 2001(a)(3)(B) and 2303, is further amended–For purposes of this title, the term `counseling and pharmacotherapy for cessation of tobacco use by pregnant women’ means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for cessation of tobacco use by pregnant women who use tobacco products or who are being treated for tobacco use that is furnished–by or under the supervision of a physician; or by any other health care professional who–is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose. If you a are dependent on tobacco and you will like to quit it you can visit www.kratomcrazy.com where you can get information about a natural drug that fights anxiety. Services recommended with respect to pregnant women in `Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline’, published by the Public Health Service in May 2008, or any subsequent modification of such Guideline; and such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women.

Section 10212 – Pregnancy Assistance Fund
The Secretary, in collaboration and coordination with the Secretary of Education (as appropriate), shall establish a Pregnancy Assistance Fund to be administered by the Secretary, for the purpose of awarding competitive grants to States to assist pregnant and parenting teens and women.

Section 10413 – Young Women’s Breast Health Awareness and Support of Breast Cancer Diagnosis
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, and in consultation with the Administrator of the Health Resources and Services Administration, shall conduct an education campaign among physicians and other health care professionals to increase awareness of breast health, symptoms, and early diagnosis and treatment of breast cancer in young women, including specific risk factors such as family history of cancer and women that may be at high risk for breast cancer, such as Ashkenazi Jewish population; on how to provide counseling to young women about their breast health, including knowledge of their family cancer history and importance of providing regular clinical breast examinations concerning the importance of discussing healthy behaviors, and increasing awareness of services and programs available to address overall health and wellness, and making patient referrals to address tobacco cessation, good nutrition, and physical activity; on when to refer patients to a health care provider with genetics expertise; on how to provide counseling that addresses long-term survivorship and health concerns of young women diagnosed with breast cancer; and on when to provide referrals to organizations and institutions that provide credible health information and substantive assistance and support to young women diagnosed with breast cancer. Health is a really important topic therefore you should try to take care of yourself in any possible way, by visiting massage chairs expert you will find a way of keeping yourself relaxed and away from stress which will benefit your health.
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To stay in compliance with the new health care reform provisions, all Gynecologists must study the provisions above. For more information and a complete list of new provisions, click HERE

What Every Internist Should Know About Health Care Reform

August 20, 2012 Leave a comment

Below is what every Internist should know about health care reform.

The new regulations provisions will have a direct impact on internal medicine. It is imperative that internists take the time to review provisions listed below, as well as any other pertinent new changes.
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Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 4104 – Elimination of Co-Pay
Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings.

Section 4108 – Incentive for Prevention of Chronic Diseases
Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Internist must take the time to read and understand the above regulations and provisions. For more information and a complete list of new provisions, click  HERE

What Every Pediatrician Should Know About Health Care Reform

August 15, 2012 1 comment

Below is what every Pediatrician should know about health care reform.  

The provisions listed below will have a direct impact on pediatric care and pediatricians need to take the time to familiarize themselves with the new regulations.
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New Pediatric Regulations

Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Child Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 2004 – Medicaid Coverage for Former Foster Children
Medicaid coverage for former foster children who were in foster care under the responsibility of a State for more than 6 months.

Section 2302 – Concurrent Care for Children
A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute a waiver of any rights of the child to be provided with, or to have payment made under this title for, services that are related to the treatment of the child’s condition for which a diagnosis of terminal illness has been made.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.

Section 5203 Subsection 775 – Pediatric Loan Forgiveness Program
The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Pediatrician  needs to make sure that they take the time to familiarize themselves with the above regulations. To learn more, please click HERE

Health Insurance Companies Profits Drop 147% Due to Health Care Reform

August 6, 2012 2 comments

Health insurance company profit falls 147% due to health care reform.

Insurance company profits are falling despite the fact that enrollment is skyrocketing. Falling profits are specifically due to insurance companies violating Health and Human Services’ ingenious medical loss ratio rule which requires companies to pay premiums on actual medical care (not profits) or be forced to pay rebates back to their customers. Insurance companies are on pace to pay out $1.3 billion this year alone on rebates. The fact that insurance company profits is falling is a clear sign that health care reform is working!
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Aetna  – Profit drops 15% (Source 5)
Cigna –  Profit drops 44%  (Source 1, 2, 4)
Humana – Profit drops 80% (Source 3, 5)
WellPoint (aka BCBS) – Profits drops 8% (Source 6)
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Health insurance company profits continue to fall due to the implementation of health care reform. Executives and  shareholders will continue to lose profits as long as they continue to violate Health and Human Services’ ingenious medical loss ratio.

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Sources:

What Every Medical Practice Manager Should Know About Health Care Reform

August 6, 2012 Leave a comment

Below is what every Medical Practice Manager should know about health care reform.

The provisions listed below will have a direct impact on medical practice management and practice managers need to take the time to familiarize themselves with the new regulations.

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Section 1001 Subsection 2712- Prohibition on Recissions
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved.

Section 1001 Subsection 2713 – Coverage of Preventive Health Care  

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Dependent Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 1421 – Tax Credit for Employee Health Insurance Expenses of Small Businesses
An eligible small employer, the small employer health insurance credit amount is 50 percent (35 percent in the case of a tax-exempt eligible small business).

Section. 3111 – Payment for Bone Density Tests
For dual-energy x-ray absorptiometry services (identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product.

 
Section 3134 – Misvalued Codes Under Physician Fee Schedule

For purposes of identifying potentially misvalued services pursuant to clause (i)(I), the Secretary shall examine (as the Secretary determines to be appropriate) codes (and families of codes as appropriate) for which there has been the fastest growth; codes (and families of codes as appropriate) that have experienced substantial changes in practice expenses; codes for new technologies or services within an appropriate period (such as 3 years) after the relative values are initially established for such codes; multiple codes that are frequently billed in conjunction with furnishing a single service; codes with low relative values, particularly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the so-called `Harvard-valued codes’); and such other codes determined to be appropriate by the Secretary.

Section  4104 – Elimination of Co-Pay

Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings.

Section  4108 – Incentives for Prevention of Chronic Diseases

Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.
 
Section 5202 –  Nursing Student Loan Repayment

The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

 
Section 5301 – Financial Assistance for Students Going Into Primary Care
To provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields of family medicine, general internal medicine, or general pediatrics training programs.

Section 5501 – Incentive Payments for Primary Care Physicians
Incentive payments for primary care physicians. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Medical Practice Manager must take time to read and understand the above regulations. For more information, click HERE