Posts Tagged ‘Medicare Help’

January’s unemployment rate was 9%, and that means that there are a lot of Americans who still need jobs. The local paper is a good way to find jobs close to home, and these days many jobs are posted online. Don’t forget that there are lots of government jobs out there too.  If you’re looking for a job or an internship with the federal government, you’ll find all federal job openings announced to the public at USAJOBS. Check out your state job bank for even more job opportunities in your area. If you need a job-seeking advice, look up your local Department of Labor office and see what services they offer to job seekers in your area.

And if the job sounds too good to be true, it probably is. Be aware of job scams.

During Women’s History Month, learn about influential women in American history, including military veterans, musicians, and a former First Lady.

Broken heartValentine’s Day is just around the corner. For me, that means I’ll be receiving a prank Valentine card in the mail from my mom, which was supposedly sent by one of the guys that I knew in my teen years. Despite her attempts to disguise her handwriting, I always know they are from her. As usual, I laugh at the card and she denies any wrongdoing. What a fraud.

Unfortunately, there are more serious frauds that are no laughing matter.  Have you heard of the term “sweetheart scam ”? It’s a term that refers to a situation where a scammer acts as if they are interested in developing a romantic relationship with you. They spend time with you (generally on online dating sites) and develop an emotional connection; however, their only intention is to take your money. Some signs to watch out for include:

  • Quick declarations of love
  • Insistence that you move your communication off of the dating site and use personal email
  • Requests that you send money to pay for travel or emergency expenses
  • Plans to visit you are prevented due to a traumatic event

Younger adults are not the only ones victimized by this type of scam. Seniors are particularly vulnerable to sweetheart scams.  In such cases, the scammer may be trying to get more than fast cash. They may also have long-term hopes of getting access to the senior’s financial assets and maybe even gain power of attorney. Isn’t that horrible?

You can report a sweetheart scam to the Federal Trade Commission for investigation. And if you choose to date online, use the same privacy tips that you would use on other social networking sites.

Do you have other tips to share about how to prevent this type of scam?

downed power linesJust a few weeks ago, I wrote a post about not being caught off-guard in summer storms. Sometimes I need to learn to take my own advice.

This past Sunday a wicked thunderstorm tore through the Maryland, DC and Virginia area. There were tornado warnings in some areas and, though I don’t think any funnel clouds were actually spotted, the storm left quite a mess to clean up.

I wasn’t the least bit prepared for it. I had no idea storms were in the forecast. I was busy helping a friend move.

By the time I got back home, I found out my house had been without electricity for eight hours. Traffic lights were out everywhere, creating back-ups while police tried to direct traffic at some of the busiest intersections.

As I stumbled up the stairs by the glow from my cell phone screen, I tried to remember where I’d stashed my flashlight. I knew I had one somewhere, but of course when I found it the batteries were almost dead so the light flickered a lot.

Luckily, my power came back on about a half hour later. Being able to run the fans and the air conditioner helped cool the stuffiness and I was lucky that none of the food in my fridge had gone bad.

Several of my friends and coworkers aren’t expecting to get their power back until the end of the week. They’re getting by on candlelight and flashlights and eating most of their meals at restaurants since all the food in their fridges has gone bad.

It’s a crappy situation all around, but stuff like this always reminds me of the importance of being prepared in an emergency. FEMA has a great list of things to keep on hand, just in case, as well as advice on how to put a disaster kit together.

I know I need to find some new batteries for my flashlight. What’s one thing you need to do to be prepared for the next big storm?

Airline travel has gotten so complicated.  Security lines are long; there are extra fees for baggage; adults need to keep out their federal or state-issued ID through the checkpoint; and there are restrictions on what can be carried onto the flight.  The Transportation Security Administration’s (TSA) website is the first place to go to find out the truth about these restrictions.

Here are three things you can’t carry on to your flight:

  1. Liquids over 3.4 ounces (including toothpaste)
  2. Scissors (blades larger than 4 inches)
  3. Knives with sharp blades, including pocketknives

Check the full list of prohibited items at the TSA website.

By the way, you can carry-on nail clippers, lighters, medications and knitting needles.

Are you curious about what happens to all the items that don’t make it through the security checkpoint?  Check out Blogger Bob’s answer on the TSA Blog.

If you have questions or comments on your security experience, you can send TSA an email via Talk to TSA.  It will be answered by the person in charge of security at the airport for which you’re commenting.  Happy traveling!

Arlene Hernandez is the manager of, the government’s official source for kids to find all kinds of government information.

When I was a teenager and hanging out at the mall, I used to see young kids whaling and crying and throwing a fit at the toy store.  I would think “Geez, what’s up with that kid?” and I probably rolled my eyes.

Now that I’m a mother of a 3-year-old, when I see that situation all I think is “Oh that poor parent… I feel your pain.”

The other night, my son had a big meltdown. He refused to put his pajamas on. First it was a whimper, but within a few minutes it was a full-blown tantrum, complete with yelling, tears, stomping and throwing his body on the floor. My husband and I were just looking at each other like “I have no idea what to do… Can someone please call Super Nanny?”

I wish that I would’ve known about the Child Welfare Information Gateway. They have a whole section on dealing with temper tantrums (also available in Spanish). Some tips to remember:

1. Redirect your child’s attention to something else, like a favorite toy or a trip to the library.
2. Remain calm and don’t lose control.
3. Hug or hold your child until the tantrum subsides.
4. Put your child in a quiet place where he or she can calm down.

So for all the parents out there – how do you deal with tantrums? Do time outs work for you? Has anyone tried using positive discipline?  Any suggestions for me and our readers?

National Institutes of Health scientists have discovered that the activation of immune cells called basophils causes kidney damage in a mouse model of lupus nephritis. These findings and the team’s associated research in humans may lead to new treatments for this serious disease, a severe form of systemic lupus erythematosus (SLE) that affects the kidneys and is difficult to treat.

Kids in poolWhen I was a little kid I can remember my mom warning me not to swim too close to the drains in pools and not to put my head under the water in hot tubs. She was concerned that my ponytail would get caught and I would drown.

I always thought that was a little morbid. I was just a kid and wanted to have fun.

But my mom had reason to be concerned. The Consumer Product Safety Commission launched the Pool Safely campaign earlier this week in response to the number of injuries and deaths from submersions and entrapments in pools and spas.

The commission released some scary statistics:

From 2005-2007, for children younger than 15, there was an average of 385 drownings in pools and spas each year.

74 percent of those fatalities happened at a home and not in a public pool.

The new campaign will help educate people about the simple steps they can take to make sure their kids stay safe around the water.

Tips include:

  • Make sure drain covers meet compliance standards
  • Install fences with self-latching gates around pools to keep children from falling in
  • Don’t let kids swim unsupervised.
  • Learn CPR to be prepared

What tips do you have for keeping you and your kids safe in the pool?

Once you decide that you want prescription drug coverage, think about what matters most to you. There are a range of plan options available, so you can focus on the kind of coverage you prefer. There are two ways you can get your Medicare drug coverage.You can add drug coverage to the traditional Medicare plan through a “stand alone” prescription drug plan.

Or you can get drug coverage and the rest of your Medicare coverage through a Medicare Advantage plan, like an HMO or PPO, that typically provides more benefits at a significantly lower cost through a network of doctors and hospitals. No matter what type of plan you choose, you can choose a plan that reflects what you want in terms of cost, coverage and convenience.

  • Cost: What you pay for the coverage, including premiums, deductible, and payments for your drugs.
  • Coverage: What benefits are provided (like coverage in the “coverage gap” and other coverage enhancements), which drugs are covered and the rules (like prior authorization) for getting those drugs.
  • Convenience: Which pharmacies are part of the plan and whether the plan has a mail-order option.

The Centers for Medicare & Medicaid Services has created an online resource, Landscape of Local Plans . This resource helps you find Medicare prescription drug plans by state or Medicare Advantage plans with prescription drug coverage by county. It lets you see the plans in your area that offer drug coverage, including basic information to help you find ones that meet your needs based on cost, coverage, and convenience.

This is the first week that you can see drug plan data. Some of the features of the Medicare Prescription Drug Plan Finder are not yet available. These features will allow you to further personalize your search for a drug plan that meets your needs. These features will be available well before you can choose to enroll in a plan on November 15.

Right now, it is important to get ready to choose a plan by making a note of the drugs you take, the coverage features most important to you, and any specific pharmacies you prefer to use. The Landscape of Local Plans is a good resource for finding out about the plans in your area to get ready to make a choice.


The best individual dental insurance on the internet:

Now, you can help someone you care about apply for Extra Help with their Medicare prescription drug plan costs. Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also are eligible for Extra Help to pay for the costs—monthly premiums, annual deductibles, and prescription co-payments—related to a Medicare prescription drug plan. The Extra Help is estimated to be worth an average of $3,900 per year.

Many people qualify for these big savings and don’t even know it. To find out if someone is eligible, Social Security will need to know the value of their savings, investments and real estate (other than their home), and their income. If they are married and living with their spouse, we will need this information for both of them.

To qualify for Extra Help, they must:

  • Reside in one of the 50 states or the District of Columbia
  • Have resources limited to $12,510 for an individual or $25,010 for a married couple living together. Resources include such things as bank accounts, stocks and bonds. We do not count their home and car as resources; and
  • Have income limited to $16,245 for an individual or $21,855 for a married couple living together.

Even if their annual income is higher, the ones you care about still may be able to get some help with their monthly premiums, annual deductibles and prescription co-payments. Some examples where income may be higher include if they or their spouse:

—Support other family members who live with them;

—Have earnings from work; or

—Live in Alaska or Hawaii.

Note: Beginning January 1, 2010, more Medicare beneficiaries may qualify for Extra Help because some things no longer count as resources and income. We will no longer count as a resource any life insurance policy; and we will no longer count as income the help they receive regularly from someone else to pay their household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes.

How will Electronic Records Express affect my work routines?

The fax and secure website options should integrate easily with existing work processes. If your records are already electronic, you will be able to upload files directly instead of printing. If your records are on paper, you can use the website by scanning, instead of photocopying your records or you can fax your records. 

Why is the letter with the barcode so important?

The letter with the barcode is important because it helps us link the records or information you send to the applicant’s unique disability folder and make any appropriate payment to you. If you do not include the letter with the barcode as the first page, there may be significant delays associating the information with the applicant’s electronic disability folder and making payment to you.  

How will I know whether my electronic record transmission was successfully received?

When using the secure website, you’ll receive an immediate tracking information page which you can print or store electronically for your records. When sending by fax, your fax machine should indicate a successful transmission including the number of pages that were sent. 

Can I amend my reports?

You may choose to amend your reports by sending new information; however, the original reports you sent will remain part of the electronic file.  

Will this change the amount that I am paid for my reports?

No, the compensation will remain the same. However, you may notice resource savings when you send records electronically to Social Security. 

How will I know the applicant is giving informed consent to have their records sent electronically?

Social Security complies with all laws and regulations regarding release of medical and school records. Form SSA-827, “Authorization to Disclose Information to the Social Security Administration,” which accompanies every request for health and school records from Social Security, contains language that specifically permits electronic processing.  

Are the Electronic Records Express options compliant with the Health Insurance Portability and Accountability Act?

Yes, both the online and fax options comply with the goals of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If used in conjunction with a properly designed and implemented HIPAA plan, these options can add significant value to safeguarding the security of your patient data. 

Are the Electronic Records Express options compliant with the Family Educational Rights and Privacy Act?

Yes, both the online and fax options comply with the goals of the Family Educational Rights and Privacy Act of 1974 (FERPA). These options can add significant value to safeguarding the security of your student data.  

How can I send in evidence when my client’s case is an electronic case? 

You can submit evidence directly to your client’s case file by using your office fax or through the Social Security secure Electronic Records Express website.  Both of these methods require that you use the specific barcode provided for your client by the state Disability Determination Services (DDS) or the Social Security hearing office that is handling your client’s disability claim.  For example, if your client’s case is at the hearing level, you would contact that hearing office to obtain a barcode for your client. 

What hardware or software will I need to use the secure website?


Most common Internet browsers will support the secure website.  If you experience issues or difficulties, call the Social Security Electronic Records Express Help Desk at 1-866-691-3061 or send them an email at for assistance.  

Are there costs to use the secure website?


No. The government provides this service free of charge.

SSA needs information about work that exists throughout the nation to determine whether claimants’ impairments prevent them from doing not only their past work, but any other work in the U.S. economy. SSA uses the DOT and its companion volume, the Selected Characteristics of Occupations (SCO), as the primary sources of information about jobs and job requirements. However, the Department of Labor last updated the DOT in 1991 and has no plans to conduct further updates. As a result, OPDR is developing short and long term strategies to obtain updated occupational information used in disability evaluation.

The short-term project consists of two parts: 1) Acquire existing, updated occupational information in a format consistent with the Dictionary of Occupational Titles (DOT), and 2) Obtain the services of an Independent Evaluator who will assess the accuracy and reliability of this occupational information. The goal of the short-term project is to provide SSA with updated occupational information that will be formatted in a manner consistent with the format and definitions found in the Dictionary of Occupational Titles (DOT). This updated occupational information will provide disability adjudicators with updated occupational information that can be seamlessly incorporated into SSA’s disability adjudication process while long-term solutions are developed.

The long term project goal is to develop an occupational information system designed specifically for SSA’s disability process. We will conduct research to obtain and classify current occupational information critical for evaluating disability. We will also conduct investigations to test policy options and to improve SSA’s medical-vocational assessment of disability claimants in light of the new occupational information we obtain. These activities will involve the collaboration of internal SSA components, already convened as the Occupational Information System Development Workgroup, that will provide guidance on policy and operational issues and end-user needs.

One important element to our long-term research is the development of the Occupational Information Development Advisory Panel established under the Federal Advisory Committee Act. The Panel will consist of occupational analysts, vocational rehabilitation experts and other relevant professionals and medical practitioners who will guide and oversee SSA’s long-term research efforts, including recommendations at each stage of research and investigation.  For additional information on this effort, please visit

The ADA specifically permits testing for illegal drug use. Drug tests are not regarded as medical examinations for employment purposes. Companies may elect to apply these tests to applicants or employees. The ADA specifically acknowledges that certain occupations, such as those in the transportation industry, may require such testing to ensure the welfare of the public. The ADA does not recognize a person who actively abuses illegal substances as having a disability. Applicants or employees abusing illegal drugs are not protected by the ADA on the basis of the drug use. A company may impose penalties on these employees and not be charged with discrimination.

Proposed Rule for Payment under the Ambulance Fee Schedule (AFS) published 5/26/06 (See AFS Regulations and Notices link.) Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (l) to the Social Security Act which mandated the implementation of a national fee schedule for ambulance services furnished as a benefit under Medicare Part B. The fee schedule is effective for claims with dates of service on or after April 1, 2002, and it applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, i.e., hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities.

Section 1834 (l) also requires mandatory assignment for all ambulance services. Ambulance providers and suppliers must accept the Medicare allowed charge as payment in full and not bill or collect from the beneficiary any amount other than any unmet Part B deductible and the Part B coinsurance amounts.

A cover sheet is provided with every year’s PUF giving detailed information concerning the amounts payable and any special circumstances pertinent for that year’s payments.


In response to several requests from the ambulance community for a national breakout of the geographic area definitions (rural, urban, and super rural) by zip code, we have prepared a table (see Downloads section below).  Please note that it is arranged by State (using each State’s two-letter postal abbreviation), and, within each State, all zip codes are listed.  There are two sides to the table – the current geographic area breakout on the left and the geographic area breakout under the Proposed Rule, which was published on May 26, 2006 on the right.  The Medicare contractor number and the locality are also included.  Please note that, in the far right column for each side of the table, R = Rural, Blank = Urban, and B = Super Rural.  None of the Super Rural areas has changed.  Please search for your State, then zip code within the State, and compare the two sides of the table to determine if your geographic area definition changes under the Proposed Rule discussion.

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) ambulance suppliers, go to the Ambulance Services Center (see under “Related Links Inside CMS” below).


National Breakout of the Geographic Area Definitions by Zip Code [ZIP, 1.4MB] 

Zip Code to Carrier Locality File [ZIP, 4.11MB] – Updated 11/13/09 

Zip Codes requiring +4 extension [ZIP, 2KB] – Updated 11/13/09 

2009 End of Year Zip Code File [ZIP, 4.17MB] 

Regional Office Contacts [PDF, 39KB] – Updated 02/12/09 

Instructions on the Submission of OPPS ASP Data for Nonpass-Through Separately Payable Therapeutic Radiopharmaceuticals and Radiopharmaceuticals with Pass-Through Status. CMS has posted guidance for manufacturers who will be submitting ASP for radiopharmaceuticals in CY 2010.  These instructions can be viewed by clicking on the document.  Please note that in light of the imminent deadline for submitting ASP data for OPPS payment beginning on January 1, 2010, we encourage manufacturers wishing to submit ASP data for the January 2010 OPPS update to contact us immediately through the OPPS mailbox at (see Related Links Inside CMS below) so we can facilitate the submission process.


Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients who have no Part A coverage, and partial hospitalization services furnished by community mental health centers. The provisions of this section were further modified by sections 201 and 202 of the Balanced Budget Refinement Act of 1999 (BBRA).

All services paid under the new PPS are classified into groups called Ambulatory Payment Classifications or APCs. Services in each APC are similar clinically and in terms of the resources they require. A payment rate is established for each APC. Depending on the services provided, hospitals may be paid for more than one APC for an encounter.

Section 4523 of the BBA also changed the way beneficiary coinsurance is determined for the services included under the PPS. A coinsurance amount will initially be calculated for each APC based on 20 percent of the national median charge for services in the APC. The coinsurance amount for an APC will not change until such time as the amount becomes 20 percent of the total APC payment. In addition, Section 204 of the BBRA provides that no coinsurance amount can be greater than the hospital inpatient deductible in a given year.

Both the total APC payment and the portion paid as coinsurance amounts will be adjusted to reflect geographic wage variations using the hospital wage index and assuming that the portion of the payment/coinsurance that is attributable to labor is 60 percent. CMS’s final rule for the new system was published in the Federal Register on April 7, 2000 (65 FR 18434). The new system went into effect on August 1, 2000.


Many seniors do not receive recommended preventive and primary care, leading to less effective and more expensive treatments. For example, 20 percent of women aged 50 and over did not receive a mammogram in the past two years, and 38 percent of adults aged 50 and over have never had a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent of the cost of many preventive services on their own. For a colonoscopy that costs $700, this means that a senior must pay $140 — a price that can be prohibitively expensive. Under health insurance reform, a senior would not pay anything for a screening colonoscopy or other preventive services. Reform will eliminate any deductibles, copayments, or other cost-sharing for obtaining preventive services, making them affordable and accessible.


The federal government pays private insurance companies on average 14 percent more for providing coverage to Medicare Advantage beneficiaries than it would pay for the same beneficiary in the traditional Medicare program. There is no evidence that this extra payment leads to better quality for Medicare beneficiaries, and all Medicare beneficiaries pay the price of these excessive overpayments through higher premiums — even the 78 percent of seniors who are not enrolled in a Medicare Advantage plan. A typical couple in traditional Medicare will pay on average nearly $90 next year to subsidize private insurance companies that do not provide their Medicare benefits. Health insurance reform will eliminate excessive government subsidies to Medicare Advantage plans, which could save the federal government, taxpayers, and Medicare beneficiaries well over $100 billion over the next 10 years.

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