The Modern Medicare Agency Blog
Different Medicare NoticesPaperwork isn't the most fun or exciting topic, and you receive a lot with your Medicare plan already. But some of that paperwork may be important notices and forms that relate to your coverage!
When you’re enrolled in Medicare, there’s a good chance you’ll be receiving plenty of paperwork in the mail. It may seem annoying, but it’s truly a good thing because it means you’re being kept in the loop with your Medicare coverage. Many of these will be notices about how you’re using your Medicare. For example, you may receive a Medicare Explanation of Benefits or Medicare Summary Notice depending on what type of Medicare you have. While these may be among the most common types you’ll encounter, there are others you should at least be aware of as well.
Notice of Denial for Payment or ServicesWhile Medicare plans cover a lot of the services and needs of beneficiaries, they don’t cover everything. If you’ve requested coverage for something that ultimately won’t be covered by your plan, the Centers for Medicare & Medicaid Services (CMS) requires your plan to send you a Notice of Denial of Medicare Coverage (or Payment). This is also sometimes called an Integrated Denial Notice (IDN). The notice must include your plan details (your name, plan number, and the date the notice was issued), along with what your request was and the reason(s) why it was denied. The coverage can be denied in full, partially approved, stopped if it was already being given, reduced, or suspended (for Medicaid services).
The IDN must also list your next steps on how to appeal the plan’s decision.
Reasons you may receive an IDN range from medical reasons to network ones. Your plan may determine that a specific service isn’t medically necessary or is with a doctor outside your plan’s network. For Medicare Part D plans, a prescription may not be on your formulary. Luckily, it doesn’t have to end there. The IDN must also list your next steps on how to appeal the plan’s decision.
Notice of Termination of ServicesIn some ways, a notice of termination of services is kind of like an IDN for specific specialized care. If you’re receiving coverage for the services of a skilled nursing facility, home health agency, or comprehensive outpatient rehabilitative facility, but it’s determined that you no longer require these services, you’ll likely receive two notices from your Medicare plan. These are the Notice of Medicare Non-Coverage (NOMNC) and the Detailed Explanation of Non-Coverage (DENC).
The notice must also include contact information for the provider, member numbers, and effective date of coverage termination.
The NOMNC is effectively advance notice that coverage will be terminated and must be delivered two days prior to the end of coverage. The notice must also include contact information for the provider, member numbers, and effective date of coverage termination. Much like the IDN, the NOMNC must also include an explanation of your right to appeal to the decision and how to file an immediate appeal. The DENC contains provider contact information, member identification, a comprehensive list of services being terminated, and a detailed reasoning why the decision was made.
Medicare Outpatient Observation Notice (MOON)One of the more confusing ways you can have unexpected out-of-pocket costs with Medicare is something called observation status. We’ve discussed this before, but essentially, observation status is when you’re in the hospital, but considered a hospital outpatient. There are a number of reasons this could be the case, but whatever the reason, your care will be covered by Medicare Part B instead of Part A. This means that you’ll have to meet the annual Part B deductible and pay 20 percent of any services you receive after that.
The purpose of the MOON is to inform the beneficiary that they are in observation status, why they are in observation status, and how this can influence their costs.
The Medicare Outpatient Observation Notice (MOON) was created in 2015 by the NOTICE Act and is sent to a beneficiary when they are in observation status. The purpose of the MOON is to inform the beneficiary that they are in observation status, why they are in observation status, and how this can influence their costs. Furthermore, this notice must be followed by a verbal explanation of the MOON, along with a signature from the beneficiary or someone on their behalf to acknowledge the receipt of the MOON. Once you know you’re in observation status, you may be able to request to be admitted into the hospital to have your care covered under Part A coverage.
Hospital Discharge NoticesA final notice we’ll be discussing, though by no means the last Medicare notice that exists, is the grouping of notices called hospital discharge notices. In essence, there are two notices worth mentioning here. First, is the Important Message from Medicare (IM), which a beneficiary receives upon entering into inpatient care at a hospital. This form simply informs you of your appeal rights for hospital discharges. In other words, it lets you know that, if you’re being discharged from the hospital and you don’t agree with it, you are able to appeal that decision.
A DND will explain why you are being discharged.
The second form is called a Detailed Notice of Discharge (DND). You’re less likely to see this one because it is only given out if you choose to appeal a discharge decision. A DND will explain why you are being discharged. This is an important step in appealing a discharge from the hospital, since your appeal will be reviewed by the local Beneficiary and Family Centered Care Quality Improvement Organization (QIO).
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Paperwork is rarely an exciting topic to discuss, but it’s very important to know about these forms if you’re someone who has Medicare coverage. Whether they’re keeping you from being discharged, letting you know a service won’t be covered so you can appeal, or telling you that you’re in observation status, these notices keep you informed about your coverage so you can be an active participant in ensuring you receive the best care and coverage possible.
Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best. If you have any questions regarding medical bills, denial of claims ect please feel free to reach out to my office we would be glad to help. 631-358-5793
The Health Benefits of Lemon Lemon is a great ingredient to use in your cooking, but can it also be healthy for you? Yes! Lemons are packed with antioxidants and nutrients that can be great for your health. We’ve discussed the value of using lemon in your cooking — how it can add brightness to a dish or balance out the fattiness. But the benefits of lemon to our health are deeper than just helping to make dinner taste nice. In fact, lemon is rich in vitamins and nutrients that can impact a number of important systems of your health. While there’s also evidence that lemon could help you control your weight, that won’t be the focus of this article. Losing weight isn’t usually the most crucial goal, as your overall health is more important. Besides, one minor change to your diet rarely makes a massive impact on your weight (sorry to disappoint you if you’re trying one of those miracle cure diets). What lemon can do, however, is become a component in an overall healthier diet that offers your body a wide range of health benefits and rich nutrients. Rich Source of Vitamin C Of all the beneficial components found in lemons, perhaps the most prevalent, and famous, is vitamin C. In fact, one lemon contains your daily recommended amount. You’ve likely seen Vitamin C content advertised on things like orange juice cartons or as a quick cold treatment, but how can it actually benefit your body? For example, Vitamin C rich fruits, such as lemons, can reduce your risk of heart disease. There’s a startling amount of evidence that Vitamin C is good for your heart. For example, Vitamin C rich fruits, such as lemons, can reduce your risk of heart disease. Lemons can also help prevent anemia — which can be caused by iron deficiency — as Vitamin C helps the body to absorb iron. Additionally, Vitamin C is thought to be linked to a reduced risk of stroke. Since some argue that there’s no correlation, more independent research is needed to verify this claim. Finally, while Vitamin C may not be as effective as advertised, it can help shorten the duration of a sickness and improve your immune system’s response time. Lots of Fiber in the Pulp Lemons are also a good source of dietary fiber, with one lemon accounting for around 20 percent of your daily suggested intake. Dietary fiber is associated with many different benefits to your health, which we’ve covered in great detail already. Among the big benefits of having a healthy amount of fiber in your diet are that it may reduce your risk of certain cancers, help you feel fuller after meals, and lower your risk of diabetes. Fiber has also been found to significantly reduce your risk of cardiovascular disease and improve the symptoms of a number of digestive disorders. So, it would be accurate to say that dietary fiber can be effective at improving your general heart and digestive health. In order to get the full benefits of the fiber in lemon, you’d need to consume the lemon itself, not just its juice. It’s also important to note that the majority of fiber comes from the actual pulp of the lemon, not just the juice, which only accounts for around one percent of the 20 percent of total daily fiber that a lemon provides. This means that, in order to get the full benefits of lemon fiber, you’d need to also eat the lemon fruit — whether that’s in baked goods or candied lemon slices. You can also get some extra fiber from the lemon peel. The easiest way to do this would be by zesting the peel to add a delicious lemon flavor to your favorite recipes. Gives an Antioxidant Boost One health benefit that often gets overshadowed is the abundance of antioxidants found in lemons. Of course, Vitamin C is an antioxidant, but there’s a type of antioxidants that lemons have in abundance — flavonoids. The most prominent of these flavonoids is the similarly named flavanones. Besides the usual prevention of oxidative stress that may help guard against cardiovascular disease and cancers, flavanones may have anti-inflammatory, antiviral, and antimicrobial properties that have a lot of potential health benefits as they become better understood. Both flavonoids prominently found in lemons can be used to make medicines due to their benefits. Two other flavonoids that are present in lemons are diosmin and hesperetin. Both can be used to make medicines due to their benefits. Diosmin may help with inflammation and blood vessel conditions like hemorrhoids. They’ve also been found to lower HDL cholesterol (the bad kind) in lab studies. Hesperetin similarly has been found to aid in lower cholesterol, but the benefits go beyond that. It may also help with wound healing and heart and cognitive health. While you shouldn’t expect these antioxidants to be curing hemorrhoids and eliminating all your bad cholesterol on their own in small quantities, as part of a healthy diet, they may be able to help. ● ● ● These are only a few of the ways that lemons can be beneficial to your health. We bet you didn’t know that there’s evidence that lemons can help prevent kidney stones, for example. While you may not want to have lemons with every meal — variety is the spice of life, after all — it’s certainly worth adding lemon to your diet. Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.
The economic situation right now is truly one of the most stressful issues that we have faced today. With the pandemic and the financial problems that come with it, it is no surprise that most people tend to become irritable and ultimately mentally unstable.
However, we should not let ourselves be defeated by our problems. If we let this happen, it might spell disaster not only for us but for our families as well because it can affect our health negatively for sure.
Here are some practical ways for you to deal with stress, especially if you feel overwhelmed.
What to Do If Your Medicare Card is Lost or Stolen Knowing what to do if your Medicare card is lost or stolen is important. Luckily, getting a replacement Medicare card is easy. Here’s how to get a new Medicare card!
You’re going through your wallet at the grocery store, ready to check out, and something is wrong. Your Medicare card, which you always keep in the same spot, is gone!
Losing your Medicare card can cause you to panic. The effect could be even worse if you know the card has been stolen. What should you do? Can you get another card or will you be fined? What if you have a medical emergency while it’s gone? These are all very common questions and concerns, and luckily, the solution is quite simple!
No matter what form of Medicare you may have, getting a new Medicare card is easy. But keep in mind, replacing the card isn’t the only thing to consider, depending on why you need to get a new card.
Getting a New Medicare Card for Original MedicareBeneficiaries with Original Medicare can request a new card in a few places. First, you can sign into MyMedicare.gov, where you’ll be able to find and print a copy of your Original Medicare card. You can also go to the Social Security Administration’s website, SSA.gov, and sign into your my Social Security account. From there, navigate to the “Replacement Documents” page and select “Mail my replacement Medicare Card.”
If you’re unable to, or do not wish to, request a new Original Medicare card online, you have two other options. First, you can contact or visit your local Social Security office, which can help you request a new card. The other option is to call Social Security at 1-800-722-1213 (TTY 1-800-325-0778) anytime between 7 AM to 7 PM Monday through Friday.
You should receive your new Original Medicare card in the mail within 30 days.
Once you’ve requested your replacement card, you should receive your new Original Medicare card in the mail within 30 days. If you need your Medicare details sooner than 30 days, you can request a letter that may act as a temporary proof of enrollment. This letter should arrive in around 10 days. These items will be sent to the address that Social Security has on file for you.
Note: If you enrolled in Medicare through the Railroad Retirement Board, you must request a replacement card on RRB.gov, by calling 1-877-772-5772 (TTY 1-312-751-4701), or by contacting your local Railroad Retirement Board office.
Replacing Your Medicare Advantage, Part D, or Med Supp CardIf you receive Medicare benefits through a private company, like a Medicare Advantage, Medicare Part D, or Medicare Supplement insurance carrier, you’ll need to call your carrier’s customer service hotline or visit their website. From there, you should be able to request a replacement card, which should arrive at your address within 30 days.
What to Do If Your Medicare Card is Lost or StolenIf your card is lost or stolen, you’ll want to report that the card was lost or stolen and get a new card. You’ll also need to watch out for Medicare fraud.
To do this, closely monitor your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) that you receive every three months or after receiving services, respectively. These notices list services provided, the amount your Medicare coverage paid, and how much the beneficiary (you) must pay.
If you notice any services or claims on the MSN or EOB that you didn’t receive or ask for, report it immediately by calling 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Inform them that you’ve found a concerning claim. You may also report it online.
Store a Copy in a Safe PlaceFinally, it’s a good idea to make a copy of your Medicare card, or record any important Medicare numbers or identifiers, so that you still have them should you lose or damage the card. While your primary care physician should have your Medicare information on file should you need to visit before getting a new card, it’s smart to have the information available on the off-chance that you need it.
If you do make a copy of your Medicare information, it’s essential that you keep it in a safe, secure location. Specifically, a safe or lockbox are good for important documents like those that contain your Medicare information, passports, or Social Security cards. Securing your personally identifiable information is the best course of action to take to protect yourself from identity theft.
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Losing your Medicare card can be scary because you’re at risk for fraud and having your personal information stolen. The anxiety is heightened if you know for sure your card has been stolen. But, if you watch for fraud and request a new card, you should be able to get things back to normal quickly!
One of the main problems you could have in your old age may be spending your retirement money. You are in luck because we will try to give you some tips regarding investments as soon as you reach retirement age. Here they are as follows:
Getting annuity insurance is one good way of ensuring your future upon retirement. It secures a steady stream of income even if you have to stop working in your old age. However, there are certain things that you still need to know about this policy before applying. Here are some of those points as follows:
As we all know, Medicare is one of the best investments you can have regarding health insurance, mainly because a private organization funds it. It means that you don’t have to deal with unnecessary additional fees or taxes to benefit from this particular insurance policy.
However, the question remains; how will you get prescription drug insurance online through Medicare? Here are a few steps that you can take.
Local Office: (631) 358-5793