Medicare Industry

Medicare Industry – A Global Perspective

Today’s India offers world class medical facilities, comparable with any of the western countries. India has state of the art hospitals and the best qualified doctors. With the best infrastructure, the best possible medical facilities, accompanied with the most competitive prices, you can get the treatment done in India at the lowest charges.

Patients from around the globe are beginning to realize the enormous potential of modern and traditional Indian medicine. Indian hospitals, medical establishments and the government of India have also realized the potential of this niche segment and have begun to tailor their services for foreign visitors. International marketing divisions have been set up by most of the top India Hospitals like Apollo, Max, Fortis, Wockhardt, etc. Some top medical tourism providers like MedicalSingapore, India4Health, MalaysiaMediTravel and IndiaHeals are helping the hospitals in this task. At a regional level, this nascent healthcare industry came to limelight with the arrival of ‘Naby Noor’ from Pakistan, who came for her Heart Surgery treatment to a hospital in Bangalore. Quite a few Indian state governments have with time, realized the potential of this ‘Healthcare industry’ and have been actively promoting it.

Visitors, especially from the United States of America, United Kingdom and the middle-east find Indian hospitals a very affordable and viable option to coping with insurance and National medical systems in their respective countries. Travellers prefer to combine their medical treatments with a visit to the ‘exotic east’ with their families, visiting places like the Taj Mahal in Agra, the palaces in Rajasthan, the serene beaches in Goa and the mountains of Kashmir and the backwaters of Kerela among others. The total price of an overseas treatment with airfare, hotel accommodation and even a few days of vacation is often far less than just the procedure cost back in the US or UK.

The year 2003 and 2004 saw a trickle of tourists from the healthcare systems of western countries seeking medical treatment in India. By the year 2005 and 2006 this became a deluge, much of it propelled by a blast of free publicity from programmes like 60 Minutes.

Illegal Medicaid Plans

Beware of Illegal Medicaid Plans!

You may have received one of those postcards promising in breathless prose how you can “save your home” and “protect your life savings” while immediately qualifying for nursing home Medicaid coverage. Too good to be true? Unfortunately, most likely yes. A recent case in Colorado brings this point home…

In 2002, Colorado Attorney General Ken Salazar alleged that an attorney, Robert Mason, together with his two sales assistants, peddled an illegal “Family Asset Protection Plan” that misrepresented to consumers

that such Plan would qualify consumers for Medicaid eligibility or for nursing home reimbursement costs;
that a revocable living trust under their Plan would shield a consumer’s assets and enable consumers to qualify for Medicaid;
that avoiding probate by purchasing their Plan can save consumers a large percentage of their assets;

Apparently, this flawed “Plan” was promoted through numerous estate planning seminars held throughout the state. They targeted older consumers through direct mail and newspaper advertisements, and invited them to a “free seminar” on estate planning. The defendants charged consumers between $1,500 and $3,000 for the estate plans they knew were defective.

The lawsuit claimed that Mason and his crew engaged in the sale of “Family Asset Protection Plans” (“Estate Plans”) which they falsely represented would shelter consumer’s assets, therefore qualifying them for Medicaid payment of nursing home care expenses.

The lawsuit alleged the defendants represented that they could qualify consumers for Medicaid even if their income and assets exceeded the statutory limits for Medicaid eligibility. A “revocable living trust” was a primary feature of the plan touted by defendants.

Unfortunately, consumers who subsequently incurred nursing home costs were surprised to learn later that they were not qualified for Medicaid. Consumers also discovered that they had to pay for their nursing home care with their own funds or with long term care insurance, despite the assurances of the defendants that their Plan would qualify them for Medicaid.

At the conclusion of the 2004 trial, the judge awarded damages totaling more than $3 million to 334 victims, most of whom were elderly.

Unfortunately, such a case paints all of us Medicaid/estate planning attorneys in a bad light. The truth is, there are many legitimate techniques available to save families thousands of dollars and qualify for Medicaid sooner. And yes, sometimes that planning can indeed cost $2,000-$5,000 for the lawyer’s time and document drafting expertise. However, there is certainly no “cookie cutter” plan available that an attorney can take off the shelf and put all his or her clients into, that would work its magic on them, instantly qualifying them all for Medicaid!

As for the attorney’s promotion of the revocable living trust as a Medicaid planning device, see my article on this very topic. The bottom line is that a living trust can indeed have great utility for estate planning and probate avoidance, but it usually offers no benefits—and can even cause major problems—in a Medicaid planning context.

So a word to the wise: Beware the high-pressure seminars where “salesman” or “assistants” are lined up at the back of the room, selling one-size-fits-all solutions. Estate planning, and especially Medicaid planning, is an extremely complex area,requiring the application of the laws to your unique family situation, and a one-on-one meeting with an experienced elder law attorney. Don’t look for a shortcut—-especially one that costs thousands of dollars!

Electric Wheelchairs and Medicare

Electric Wheelchairs and Medicare – What You and Your Family Need to Know

It’s been an interesting few years for those that follow the relationship between the electric wheelchair industry and Medicare. Fifteen years ago, chances are you never heard of electric wheelchairs. Although they have been around for longer than that, they were not readily available until the past 10 to 12 years.

That’s when companies like The Scooter Store and Hoveround began to market the wheelchairs nationally in the same manor that diabetic supply companies promoted diabetic medical supplies that were Medicare covered. When these companies began their national advertising campaigns for electric wheelchairs, the demand for the equipment nearly tripled in under three years (from 1999 to 2002). The Medicare expenditures for these wheelchairs increased by a whopping $556 million over this time period.

This does not, however, mean that the increase has been a bad thing for Medicare. According to a 2005 independent study, the electric wheelchair industry actually saves Medicare billions annually because Medicare people who receive electric wheelchairs tend to be healthier overall and suffer fewer injuries. The study found that the rate of people with broken hips was significantly lower when individuals had electric wheelchairs.

Over the past three to five years, the electric wheelchair industry and Medicare have battled over who should qualify for this type of medical equipment and how much Medicare should pay for those that receive it. Last year, Medicare finally released what seems to be the new directive for pricing and eligibility for electric wheelchairs. Below is a brief overview.

Medicare Electric Wheelchair Eligibility

To be eligible to receive an electric wheelchair through Medicare a person must have what is considered a daily living activity need for it and that need must be inside the home. Medicare currently does not covered electric wheelchairs or scooters for people who exclusively need them outside the home.

Daily living activities include feeding, bathing, dressing, toileting and so on. What does this really mean? It means that a person must need the chair to get around inside the home for at least one of these activities. Medicare will only consider the person eligible if he or she cannot conduct these specific daily living requirements with the use of a manual wheelchair, cane, walker or freely.

How Much will an Electric Wheelchair Cost?

The pricing for electric wheelchairs differs throughout the country. Whatever the allowable price is in your area, Medicare will typically pay for 80 percent of the cost. The remaining copayment may be picked up by your supplemental Medicare insurance if you have one. If you do not, you are responsible for the remaining 20 percent (normally between $1,200 and up).

How Do I Get an Electric Wheelchair?

You need to first ask your doctor if you are eligible and if you meet the minimum Medicare requirements. If your doctor says you do, then contact a medical equipment supply company (either a local one or a national one like The Scooter Store or Hoveround). The medical equipment supply company will direct you what to do next.

Healthcare Crisis

Healthcare Crisis in America

Healthcare is one of the biggest problems in the country. Every day, millions of Americans are going without quality healthcare. This report will address the problem and show you a simple solution to get immediate savings on many of your medical and dental expenses, even if you are uninsured or underinsured.

If you watch TV, read the newspapers, or surf the internet, you’ve seen the topic of healthcare in the media. It seems there’s something in the media every week about the topic of healthcare. The United States of America has one of the best healthcare systems in the world and yet so many people in this country go without quality healthcare.

It’s getting harder and harder to afford good healthcare

Recent studies show that there are 44 million Americans with no health insurance. In addition to this, there are 70 million people that are underinsured. The federal government is constantly working to solve this growing problem, but unfortunately, it increases year after year.

The federal healthcare plan never got off the ground

The best effort so far was an attempt to create national healthcare for all Americans. Congress refused to approve this proposal and the issue has been on the shelf for several years now. Maybe one day a national healthcare system may surface, but no time in the near future.

Then individual States tried to fix the healthcare system

After the federal government’s attempt to regulate healthcare was placed on the back burner, more states created their own state-specific healthcare regulations. Today, there are hundreds of regulations nationwide for healthcare. The more regulations each state requires, the more the cost for health insurance goes up, making it harder for people to afford.

Over 1 million people filed bankruptcy in 1999… 40% of them were related to medical bills!

Just two years before, in 1997, only 28% of the bankruptcies were related to medical bills. What’s happening here folks? Why the dramatic increase of bankruptcies due to medical bills? Why is this happening in a country that has one of the best healthcare systems in the world?

The uninsured vs. the underinsured

Harvard law professor, Elizabeth Warren, did a study about the rise in bankruptcies due to medical bills. The results of this study revealed that most of these medically related bankruptcies were filed by people who actually had health insurance.

Will Medicare Cover My Lift Chair

Will Medicare Cover My Lift Chair?

This is often the first question that is asked when shopping for a lift chair. Medicare will no longer reimburse the entire cost of the lift chair but it will pay for the cost of the lifting mechanism. Under Medicare, the lift mechanism is considered durable medical equipment (DME) which is covered if your doctor prescribes it for use in your home. The total amount of reimbursement can vary from state to state, but it is usually around $300.

You will have to pay for the chair up front and then fill out a claim to Medicare for reimbursement. Reimbursement may be made for a purchase of medically necessary lift recliners but the patient must suffer from severe arthritis of the hip or knee, muscular dystrophy or from other neuromuscular diseases. Medicare policy states that the it must be included in the physician’s course of treatment, that it is likely to effect improvement, or that it may arrest or retard deterioration in the patient’s condition.

Additionally, the coverage of the lift mechanism of the recliner is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. There is a type of lift that is operated by a spring release mechanism that is not covered by Medicare because of its sudden, catapult-like motion.

How To File for Reimbursement

It’s actually a fairly simple process. You will need 3 things to file.

A CMN (Certificate of Medical Necessity)
A bill of sale
A doctor’s prescription for a lift chair recliner and your doctor’s signature on the CMN.

Most distributors will provide the CMN straight from their website or through the mail and will also provide you with the bill of sale after purchase. There are 5 questions your doctor will need to answer on the CMN.

1. Does patient have severe arthritis of the hip or knees?

2. Does patient have a severe neuromuscular disease?

3. Is the patient completely incapable of standing up from a regular armchair or any chair in his/her home?

4. Once standing, does the patient have the ability to ambulate (walk or move about)?

5. Have all appropriate therapeutic modalities to enable the patient to transfer from a chair to a standing position (e.g., medication, physical therapy) been tried and failed? If YES, this is documented in the patient’s medical records.

Once your doctor has completed and signed the CMN, you must then mail it with a copy of your prescription for the lift chair to your Medicare regional claims office. If you are approved, a reimbursement check will be mailed back to you.

Medicare Prescription

Medicare Prescription Drug – A Lifesaving Plan For Senior And Disabled Persons

There is a saying that health is wealth. But life is unpredictable, full of twist and turns and if you do not plan ahead it can spell disaster for your personal well-being and your budget. So having a Medicare Prescription Drug Coverage is vital to wellness and peace of mind.

Imagine yourself as a Senior citizen and you were driving along in a familiar street, enjoying the summer air floating inside your car; it seems like a perfect day as you passed by beautiful houses and happy looking people. Suddenly a sharp pain was felt in your chest. You become dizzy, your vision becomes blurred, and you can’t even remember if you managed to stop the car.

You woke up inside a hospital. The joyous feeling was replaced by fear. Somewhere along the way, you discovered a part of you is missing. You just had a heart attack! But you thought it would not happen to you. You were after all, can be considered a health conscious elderly. Worst! What ever pain that ails you, it becomes intense as you think about the hospital bills and the drug expenses.

That is why having Medicare prescription drug coverage is as important to any individual because not having any health care coverage at all can be a drain in the Family’s pocket. Since January 2006, voluntary outpatient prescription drug benefit took effect. It is available to millions of elderly and disabled beneficiaries who enroll in private plans approved by Medicare to offer coverage. Medicaid is now being replaced by Medicare as the primary source of doing coverage for disabled and low-income people.

There are two types of Medicare Prescription Drug Plans:

A) Stand-alone prescription drug plans (PDP) for people getting other Medicare benefits like the fee-service program.

B) Medicare advantage prescription drug (MA-PD) plans, such as HMO’s or PPO’s that cover drugs and other Medicare benefits.

Medicare Prescription Drug covers for the payment for both generic and brand named drugs; it also offers a choice of plans to Medicare Beneficiaries. There are four ways that Medicare Drug plans may require you to pay your share and these are:

1.Premium

2.Deductible

3.Copay

4.Coinsurance

Cost will vary depending on which plan you choose. There are some people that can qualify for extra help paying for their cost. You can also contact the Social Security Administration should you think you are not qualifying for extra help.

Most Medicare drug plans require that you used a pharmacy. It has a list of pharmacies called the “Pharmacy Network” on which you can used to get your prescription filled. While the start of 2006 is a very good year for Seniors without coverage that can now avail of the Medicare approved plan that would cut their yearly drug cost in half, in return for a $35 monthly premium while low-income Seniors will received additional help from a $600 annual subsidy.

But before getting a plan, figure out first what plan is best for you that give overall value. Consider the cost coverage, and convenience. Determine if you went a higher monthly premium, but a lower copay or coinsurance on each prescription or pay a higher copay or coinsurance on each prescription but for a lower premium.

What ever you decide, regardless of your income, illness or status everyone needs a Medicare Prescription Drug plan, it offers savings and it will ease the burden on your family expensive cost of drugs out in the market today. So do plan your health needs. It’s one of your best investments which help you be prepared for unexpected medical expenses.

Diabetes and Medicare

Diabetes and Medicare

In this article I will tell you about diabetes and exercises use to reduce diabetes from the body. Diabetes is a disease in which blood glucose, or sugar, levels are too high. Diabetes is a set of related diseases in which the body cannot regulate the amount of sugar in the blood. Without enough insulin, the glucose stays in your blood. Over time, having too much glucose in your blood can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease. Diabetes can damage heart, liver, and kidney and can cause blindness, and much more.

Approximately 75% of diabetes dies of heart disease, strokes, or other type of blood circulation problem.

Types of diabetes
Type 1 diabetes usually develops in children or young adults.

Type 2 diabetes results when the body does not produce enough insulin and.

To manage your diabetes well, it is very important that you:

Don’t smoke
Keep your blood glucose levels in your target range
Keep your weight in a healthy range
Take your medication as prescribed

Diabetes Treatment

Before the discover of insulin everyone with type 1 diabetes died with in a few year.The most effective treatment of diabetes consists of exercise and proper nutrition. Treatment should also include quitting smoking, maintaining good blood pressure readings. The most common of the early symptoms of diabetes is excessive thirst. And the most effective way to reduce diabetes is to adequate rest during exercise sessions to prevent high blood pressure, use low impact exercises and avoid heavy weight lifting, and always have a supply of carbohydrates nearby. Proper exercise and nutrition are the best forms of preventing diabetes. Treatment of type 1 diabetes: Type 1 Diabetes must be treated with insulin shots. This involves injecting insulin under the skin in the fat.

Health Care System

Reorganize the Health Care System

All citizens of our country deserve the security of universal health care that guarantees access based on needs rather than income.

It is a fundamental human right and an important measure of social justice. The government should play the central role of regulating, financing, and providing health care. Everyone faces the possibility of poor health.

The risk should be shared broadly to ensure fair treatment and equitable rates, and everyone should share responsibility for contributing to the system through progressive financing.

The cost of health care is rising. Over the past years its expenditure have risen faster than the cost increases reported in other sectors of the economy. As a matter of fact, the free market doesn’t work for the health care system.

* * *

There are two ways of financing health care:

The first is a private method of financing, by means of using workers’ and corporations’ money as premiums for acquisition of private insurance, which provides medical care. The established order leaves far behind 47 million people without health insurance.

The second way, which is used by all developed countries of the world, is by taxing the workers for health care, which generates a pool of money, financing it through the budgets of the countries. The people of our country prefer private medical insurance and private health care. Getting accustomed, in the course of time to the existing system, our people reject all other proposals independent of their merits.

An analysis of the acting system of private health insurance shows that this in essence is a social method of distribution of collected premiums. The insurance companies collect premiums from all insured workers and spend a part of them for health care of needy patients. As we see, private stays only the misappropriation of profits. Social distribution is carried out not on the scale of the full country, but is only limited by every medical insurance company.

Medical insurance companies use as the basis of their operations an unfair practice. They select for medical insurance only relatively young, healthy, working people, which rarely are sick. They constantly increase the premium rates, excluding retirees who need substantially more care. Thus, the health insurance companies established for themselves hothouse conditions. They make billions of dollars in profits, which in essence is a simple misappropriation of unused means of healthy people, that don’t need medical services. Justifiably these means should be set aside in a special fund and used for care when these workers retire.

Under the existing system, medical insurance companies have every reason to limit our care and increase our co-payments and deductibles. HMOs are famous for refusing to cover necessary hospital stay, denying people coverage for emergency room visits and balking at medically necessary procedures and therapy. The main reason our system is so expensive is that it has to support profit-hungry HMOs. In the U.S. thirty percent of each premium dollar goes to pay for administrative expenses and profits.

HMOs stand as a useless obstacle in between doctors and their patients. A question occurs. It is necessary to have HMOs in the system?The answer is clear. There is no need for HMOs. This is an unnecessary link and it need to be abolished. It is necessary to establish a system that allows providers to concentrate on care, not on profit margins.

* * *

The health care system needs a fundamental change and improvement. It consists precisely that is necessary to decide a ripe task about improvement of medical care, simultaneous lowering the expenditures and providing all citizens of our country with goo care. This major problem brooks no further delay. It is generally known that health care in our country equates with small business, and all participants are interested, like every business, in receiving the highest possible profits.

Breaking up the medical care into small medical offices don’t favor the development in this field and the fundamental medical tasks of lowering the cost of medical care by following reasons:

advanced medical technology can’t be used in these offices;conditions don’t exist for a high level of organized health services;doctors prefer to minimize the time for medical examination of patients;fee for service is not the best idea in this field.

The enumerated shortcomings in its turn lead to:

the growth of serving medical staff and administrative expenses;deterioration of efficacy of outpatient treatment, increases visits of patients and needless referrals to hospitals;aggregate increase of expenditures on medical care.

* * *

Under existing circumstances of irrational organization of medical care in our country, it is necessary to look for new structures to satisfy the requirements of contemporary reality.

Inevitably comes to mind a conclusion of advisability to reorganize the whole structure of medical

Healthcare Advertising

5 Surprising Benefits of Outsourcing Your Healthcare Advertising

Healthcare advertising is needed to have a successful healthcare facility because you are essentially running a business. With all of the diversions around you that will take up your attention, it’s hard to imagine having the time to sit down and handle your advertising as well.

That said, here are five benefits of outsourcing your healthcare advertising operations that you may not have thought of before:

1. Time – You are busy and far too involved with other matters throughout the day. Carving out time here and there for things such as a relaxed lunch with clients, walking the halls of your facility, or even spending time with your family would be almost impossible if you did all of your own advertising. By outsourcing your advertising, the agency in question can dedicate the time necessary to make things start moving in the right direction.

2. Not Wasting Money – A lack of productivity does not equal saving money. Whether it’s you or someone on your team, allowing your schedule to be interrupted by advertising amounts to losing money & skimping on quality An outsourced advertising agency can take its time to not only help develop a plan of action, but they can also get started ASAP.

3. Getting You Name Out There – Advertising agencies know how to make businesses become successful. They know how to work with the community-at-large, understand the make-up of the community & what their needs are, and can then help bring it all together to create a rock-solid plan of action.

4. Putting A Plan Into Action ASAP – A separate healthcare advertising agency can get the wheels in motion on a marketing plan immediately. Time is always of the essence in business, so this skill is crucial. This quick work is beneficial for a healthcare facility as it does keep you and your team on its toes. You need to be organized because that organization translates into your outsourcing agency having everything it needs to do its job as effectively as possible.

5. Assessing Your Own Success and Failure – A successful advertising campaign requires assessment. Having a plan in place does not mean that things are moving In the right direction. Has your business picked up? Do you have a solid presence on social media? It is nearly impossible to honestly see how well, or how poorly, you are doing. What’s worse, if there is a need to change directions in your advertising, you may find out much too late to fix what is wrong. Outsourcing your advertising allows you to have a better perspective on success and failure, and in business, anything that gives you the chance to see what is working or not from the outside is worth its weight in gold.

Healthcare

Engaging the New Healthcare Customer

The healthcare industry business model has transformed in fundamental ways and is now driven by consumerization. Healthcare providers have started aligning organizational focus to the patient using digital transformation methodologies.

Healthcare organizations are looking at new ways to leverage technology to improve costumer engagement and experience. Digital transformation not just contributes to greater health outcomes for patients but also benefits the bottom line of healthcare providers.

The new healthcare customer is highly informed, engaged and involved. When a differentiated customer experience is provided to them it can lead to satisfied customers and this in turn results in creating more potential market share and revenue growth.

The connection between revenue growth and customer satisfaction is becoming increasingly clear. Failing to live up to the expectations of the customer has an impact on the bottom line of the healthcare providers.

Reputation, brand, revenue growth and market share are all at risk if the customer has a negative experience. In today’s digital world poor customer service and bad experiences can have a significant impact on the customer’s decision regarding where to obtain healthcare.

Attracting and retaining new customers is no longer restricted to hotels, banks and retailers. Healthcare providers also need to focus on the ability to attract and retain customers. Customer expectations have evolved over the years and only those providers that cater to this change will succeed.

Innovative Digital Transformation Initiatives

Patient Management Initiative

Define opportunities by enhancing patient access process, improving data integrity and reducing insurance denials. The data and observations need to be synthesized to form insights.

Customer focus can help in uncovering themes that are usually not obvious. The journey map to define the capabilities required for customer focus can be identified with thoughtful exploration.

Discover Needs of Customers

Digital tools can be used to satisfy the desire of customers for engagement. Most organizations do not know which tools to use.

Organizations need to clearly articulate goals by engaging with customers and observing their behaviour, challenges, needs and opportunities. A proper patient engagement strategy can help in determining the right tools that you need to use to transform customer experience.

Solutions

It is important to understand what improves clinical effectiveness, drives customer loyalty, health outcomes and improves patient engagement. Involve customers to co-design solutions and develop concepts that can be tested on real users. Define the key operating model changes that are necessary to support the organization in the future.

Decide on Initiatives

When market competition is considered, it is important to have a strategic plan that caters to patient engagement. This is essential for achieving performance related results. A roadmap is required for delivering services and products. This can also help in prioritizing customer needs and preferences.

Enhance Customer Experience

The ongoing benefits need to be monitored to enhance customer experience. The initiatives need oversight. If customer expectations are not met, technology can help pinpoint the issues. This can help get the initiatives back on track.

Value and not volume is the guiding principle of the new healthcare system. The shifting focus has had a significant impact on how patients are cared and how healthcare providers are paid. This has led to increased patient choice with the focus on outcomes.

The new digital technology has created an innovative patient and provider contact mechanism. This unconventional communication channel has enabled on demand access to personal health data and scheduling.

Creating Value for a New Healthcare Customer

When it comes to creating value for customers, healthcare providers need to extend their focus beyond quality of care and price. They need to focus on engagement, convenience and other intangible factors like culture. Multiple strategies need to be designed to guide the digital transformation initiatives that are necessary to meet the customer demands.

Success in providing optimal patient experience is demonstrated through increased market share and enhanced brand value. The priority should be to engage with tomorrow’s patients. Customer engagement platforms create innovative ways to expand customer relationships.

When patients are the primary focus of healthcare providers they are most likely to report, better experience compared to other providers. In order to provide better support to customers, healthcare organizations have undergone phenomenal reorganization and transformation that has helped establish processes that facilitate changes by keeping the customer at the center.