Gary Guinto Insurance

09/03/2024

Hey all! The annual Enrollment Period is incoming. Post your questions below!

09/28/2022

Medicare Premium Info for 2023!

As always September is the month for all Medicare updates, plans, premiums, adjustments etc. Two days ago, Medicare and Medicaid services released the latest. As a Medicare recipient you know that Medicare Part A covers hospital stays, skilled nursing, hospice care and Medicare Part B covers what is...

03/13/2022

https://www.aarp.org/politics-society/advocacy/info-2022/medicare-prescription-drug-costs.html?cmp=EMC-DSO-NLC-WBLTR---MCTRL-031222-TS1-6214717&ET_CID=6214717&ET_RID=116381461&encparam=t9fB0Ku9YsvABUMF6GGIKyjho1rUif8e6%2Bj17wsI5%2Fg%3D&fbclid=IwAR1i4miYTJ4sda2V_hM2Y4HG9tzAQoFzTZYQmziRMF8-f55Ibo3OcZexkUc

AARP research finds brand-name prescription drug manufacturers are still increasing prices. Here are 10 drugs that cost Medicare the most.

02/14/2022

11/13/2021

2022 Part B premium: 170.10 (prev 148.60)
2022 Medicare deductible: 233 (prev 203).

Big increases!

10/12/2021

The Annual Enrollment Period is upon us! Lots of new plans out there.. send me a message if you’d like me to run some numbers or answer any questions!

09/13/2021

https://www.forbes.com/sites/nextavenue/2021/09/10/what-the-new-outlook-for-social-security-means-for-you/

Read this if you’re on SS!

A new report examines solvency issues for Social Security and Medicare

07/15/2021

https://www.kff.org/medicaid/issue-brief/how-might-the-fdas-approval-of-a-new-alzheimers-drug-impact-medicaid/?fbclid=IwAR2jdVtbDJFfGEAMgmXDOyrRUMRc8fKYSwn3mQCgc3a71QE2xhLQGqvFgr0

The brief examines the potential impact of Aduhelm, a newly approved drug for Alzheimer’s disease, on state and federal Medicaid costs and looks at potential policy actions that could limit M…

03/31/2021

https://youtu.be/MU5DDDtXZRY

This video looks at Amlodipine side effects and presents 4 HACKS to reduce side effects!.The main question asked in this video is : What are the side effects...

02/25/2021

HEAD UP! A Message from the Office of Inspector General.

The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about fraud schemes related to the novel coronavirus (COVID-19). Scammers are using telemarketing calls, text messages, social media platforms, and door-to-door visits to perpetrate COVID-19-related scams.

Fraudsters are offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal details, including Medicare information. However, these services are unapproved and illegitimate.

These scammers use the coronavirus pandemic to benefit themselves, and beneficiaries face potential harm. The personal information collected can be used to fraudulently bill federal health care programs and commit medical identity theft.

Protect Yourself

Offers to purchase COVID-19 vaccination cards are scams. Valid proof of COVID-19 vaccination can only be provided to individuals by legitimate providers administering vaccines.

Photos of COVID-19 vaccination cards should not be shared on social media. Posting content that includes your date of birth, health care details or other personally identifiable information can be used to steal your identity.

Be vigilant and protect yourself from potential fraud concerning COVID-19 vaccines. You will not be asked for money to enhance your ranking for vaccine eligibility. Government and state officials will not call you to obtain personal information in order to receive the vaccine.

Beneficiaries should be cautious of unsolicited requests for their personal, medical, and financial information. Medicare will not call beneficiaries to offer COVID-19 related products, services, or benefit review.

Be suspicious of any unexpected calls or visitors offering COVID-19 tests or supplies. If you receive a suspicious call, hang up immediately.

Do not respond to, or open hyperlinks in, text messages about COVID-19 from unknown individuals.

Ignore offers or advertisements for COVID-19 testing or treatments on social media sites. If you make an appointment for a COVID-19 test online, make sure the location is an official testing site.

Do not give your personal or financial information to anyone claiming to offer HHS grants related to COVID-19.

Be aware of scammers pretending to be COVID-19 contact tracers. Legitimate contact tracers will never ask for your Medicare number, financial information, or attempt to set up a COVID-19 test for you and collect payment information for the test.

If you suspect COVID-19 health care fraud, report it immediately online or call 800-HHS-TIPS (800-447-8477).

01/04/2021

Changes to Medicare that may affect you.

Medicare has been hard at work to address the documentation burden placed on clinicians, physicians, physician assistants, nurse practitioners, and other medical providers. Some major changes are beginning January 1, 2021 thru the “patients over paperwork “initiative. One initiative that has been launched involves streamlining how providers report and document their services. Medicare recognized an opportunity to help resolve provider complaints regarding the documentation burden associated with Office visits also known as Evaluation and Management (E/M) Visits. Clinical care involves complaint or symptom-based face-to-face encounters between a patient and clinician. The intensity of this work often requires complex medical decision-making and care coordination. Clinicians had to perform and document the visit with significant detail, some of which was (I think) of only marginal relevance to the visit. Beginning in 2021, billing and documentation for visits will be simplified.
The clinician will perform a “medically appropriate” visit and identify the “nature of the presenting problem” or reason for the visit as described by the patient.

The presenting problem is identified as
· minimal – Only needing a nurse working under the supervision of the clinician who may not need to be present in the room. i.e. suture removal for a simple repair of a superficial wound.
· Self-limited or minor which refers to a problem that is expected to have a definite course and is temporary or has a good prognosis. An insect bite is a possible example.
· Low severity - problems have a low risk of morbidity and little or no risk of death even with no treatment. A patient should be able to recover from this level or problem without functional impairment. An example might be sinusitis.
· Moderate severity problems have a moderate risk of morbidity or death without treatment. The prognosis is uncertain or extended functional impairment is likely. Some cardiac events may fit this category.
· High Severity problems have a high to extreme risk or morbidity without treatment. The risk of death with no treatment is moderate to high. Sepsis might fit this level.
If the patient presents with a moderate severity problem, the clinician may wish to bill the visit based on the level of Medical Decision Making. This includes establishing a diagnosis, assessing the status of a condition, and/or selecting a management option. Clinicians may bill their services base on the Medical Decision Making required to treat the presenting problem.
If the nature of the presenting problem is low but time was needed to counsel or educate the patient, the clinician may choose to bill the visit based on time. A visit typically includes preparing for the visit i.e. reviewing tests, getting or reviewing a history, performing an exam, counseling and providing education to the patient, family, ordering medicines, tests, procedures, documenting information in the medical record, and sharing that information with the patient plus care coordination. Time does NOT include activities the clinical staff normally performs.
A minimal presenting problem visit might necessitate only 15-29 minutes.
A low severity low risk (i.e. recheck of a resolving problem, or routine evaluation of a chronic problem) presenting problem may require 30-44 minutes.
A moderate severity presenting problem may require reviewing/ordering tests, a minor procedure, counseling, or providing education. The visit may require 45-59 minutes. The clinician will use “Total Time” to bill the visit which must be within the above times and the time must be documented in the record along with a description of the visit.
I believe a majority of visits going forward will be billed based on time. The patient's complaints of “the doctor was only with me for 5 minutes” may diminish because documentation of the visit is simplified and the time needed to complete it significantly reduced. Patients may want to identify the total time the physician was in the room with them. I encourage patients to access their medical record after every visit and read their physician's visit note. It helps us to remember instructions given, but also can identify any errors in the record or claims.
A personal example: My husband was scheduled for a heart catheterization and instructed to get a blood test the day before the procedure. When the Medicare explanation of benefits and physician bill arrived, that blood test was denied as “not covered”. I did a little research and discovered the wrong diagnosis code had been used to support the lab charge. The claim was refiled and the lab work was paid. That $300 charge was paid by Medicare at $8.00. A good reason to read every explanation of benefits and question all denied charges. You are the only one who will initiate getting corrections made.

If you changed your insurance this year, be sure you provide the new information to your physician's practice and validate that it was updated at several subsequent visits. One of the most common reasons for denied claims is invalid insurance or an error in the ID numbers.

11/11/2020

Just off the Presses. . . .(old people know what that means).
Heads up Team! Below are some terms that are new to Medicare. You need to become more aware of This type of insurance just in case. SPECIAL NEEDS PLANS

https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans

The Medicare program pays Special Needs Plans on a capitated basis (specific $$ per month per patient) and requires that each have a Model of Care (MOC) approved by the National Committee for Quality Assurance (NCQA). The MOC provides the basic framework under which the SNP will meet the needs of each of its enrollees. There are three types of SNPs: Dual Eligible SNPs (D-SNPs), Chronic Care Special Needs Plans (C-SNPs), and Institutional Special Needs Plans (I-SNPs).

SNP types differ mainly in the populations they serve.

What are the benefits of a Medicare Special Needs Plan?

SNPs provide personalized guidance and resources to help members get the right care and information based on their specific conditions or needs. The plan may offer extra benefits tailored to the groups it serves, such as diabetes services, care coordination or other health and wellness programs.

Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to Medicare Advantage eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF),or a SNF/NF, an intermediate care

Medicare MSA Plans don't cover Medicare Part D prescription drugs.

Who qualifies for Medicare special needs plans? A plan must limit membership to these groups: 1) people who live in certain institutions (like a nursing home) or who require nursing care at home, or 2) people who are eligible for both Medicare and Medicaid, or 3) people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD).

How are I-SNPs unique?

Facility settings can support effective care management, and I-SNPs can reward providers for the avoidance of resident hospitalizations.

I-SNPs originated from a demonstration of the Evercare model, in which onsite nurse practitioners in nursing homes deliver care aimed at reducing unnecessary hospitalizations.

Facility operators have the ability to observe a complex care population in their home environment and to manage health care for many high-need individuals in one location.

ARE SNPS HERE TO STAY?

Yes. In 2003, Congress authorized SNPs to market to special populations. SNPs were first offered in 2006. Authority for SNPs was extended in various laws, including the Affordable Care Act. On February 9, 2018, President Trump signed the Bipartisan Budget Act of 2018, which included the CHRONIC Care Act, which permanently authorized SNPs.

You will be hearing and seeing an uptick of SNPs in NC. I am reviewing a Medical Practice contract with a Nursing Home focused SNIP now. They will be up and running in Charlotte very soon. If you want to know more, I can add to this information as I find out more myself.

General information on special needs plans (SNPs)