The Action Benefits Company

#Medicare does cover medically necessary joint replacements. But how it's covered -- and what you'll pay -- depends on where the procedure gets done. If the procedure is done in a hospital, and you stay overnight to recover, Medicare Part A will kick in. You may face a deductible of $1,632. What if it's done on an outpatient basis, and you go home the same day? Medicare Part B will cover it. You'll be subject to a smaller deductible, plus 20% coinsurance. And, a #MedicareAdvantage plan will have its own coverage rules.

So, fraudulent catheter billing is a thing. In 2023, it was a three billion dollar thing. A thing that increased some #Medicare Accountable Care Organizations' spending by 2%. The Centers for Medicare & Medicaid Services recently proposed a rule to exclude catheter billing codes from revenue and spending reports in 2023. The move hopes to give a clearer picture of what Medicare spending looked like that year, and better inform policy decisions. The American Hospital Association. with others, supports the proposed rule.

A recent JAMA study confirms what you might already suspect as someone selling #healthinsurance plans: the lower an area's socioeconomic status, the lower the star rating on the #MedicareAdvantage plans available in that area. Areas of average socioeconomic status had a mean star rating of 4.1, while the most disadvantaged areas came to 3.8. #Medicare

You CAN wear white on and after Labor Day. Just be careful with the barbecue sauce. We're closed today, as we celebrate the contributions of our teammates. We'll be back in Action on September 3. Right after we find the Tide pens.

Eli Lily's #Zepbound might overtake #Ozempic as the most popular #GLP-1. The drug manufacturer will start selling Zepbound to consumers directly on Tuesday for $399 a month for a lower dose and $549 for the higher dose. This is about 50% off the sticker price. How can they afford to discount the price so steeply? The drug will be sold in vials instead of the usual auto-injector packaging. This reduces production cost and time, with that savings passed down to the consumer. #healthcare

David Blackburn is a great asset to this company, and we are proud to have him!

Although it's not official, many Americans feel we are in a recession. #Healthinsurance agents can use this to their advantage. Quick tip: clients who feel their advisors "frequently" contact them during a recession feel comfortable with their plan, while that number is only 22% for those rarely contacted. The higher-value the client is, the more likely they want to hear from their agent personally. Don't let your clients become strangers over the year! Even if you are just sending them a birthday email or updating them on #healthcare news, it's never a bad idea to keep yourself in the forefront of your clients' minds.

Real story: One of our teammates had an MRI done on his foot. And, neither he, nor his doctor's office, was equipped with a CD-ROM drive to read the results. Because, it's 2024. Who even uses CD-ROM drives anymore? A growing number of radiologists are calling for their profession to ditch the disc and move to storing imaging results in EHRs or other secure online platforms. The move would help providers better prepare for appointments and save the hassle (and risk) of dealing with physical media.

The federal government will make another round of free #COVID tests available for order in late September from https://bit.ly/4cKJiwZ. Up to four tests can be shipped to US households before the holidays.

47% of Americans don't know they can fight #healthinsurance coverage denials. But, studies show just over half of appeals are successful. That means a good portion of your clients are paying for things their plans should be responsible for. Help them put dollars back in their pocket by educating them about the appeal process with their carriers. They -- and you -- will be glad you did.