Medicare Case Study
This is a follow-up email in reference to Sandra Anacker 's application for AARP Medicare Supplement. In review of the application questions answered on page 5 are indicating currently receiving medical assistance through the state 's Medicaid program other than the Medicaid payment toward the Part B Premium, as described on the letter received. If the client 's status with Medicaid is changing, a new application may be submitted for review with the questions answered
Hi everyone! Hope all is well… Here is some important information: 1. 2014 Medicare Part B IRMAA & 2015 Medicare Part B Standard Reimbursements – Update #2 – By now, all those eligible Medicare retirees who have their pensions deposited electronically should have received their 2015 Medicare Part B standard reimbursement and, if eligible, their IRMAA reimbursements electronically (provided you applied for it in a timely fashion) on or about June 17.
A Medicare Severity-Diagnosis Related Group (MS-DRG) is a system of sorting a Medicare patient’s hospital stay into many groups in order to expedite payment of services for Medicare patients (CMS, "Acute Inpatient PPS") . The MS-DRG is the most-widely used system today as a result of the rising number of Medicare patients. Payments are calculated using wage variants, geographic locations, and the percentage of Medicare patients that a hospital treats (CMS, "Acute Inpatient PPS"). In short, the Medicare Severity-Diagnosis Related Group (MS-DRG) system enables the Centers for Medicare and Medicaid Services (CMS) to provide improved reimbursements to hospitals serving more severely ill patients. Hospitals treating less severely ill patients will receive less reimbursement.
Prior to the implementation of the Affordable Care Act (ACA), few people anticipated employer-provided health care would disappear as a major player in the United State healthcare arena. However, ACA adoption and has put more than 169 million employees at risk for losing their workplace coverage. Several studies indicate employer-based coverage will decline rapidly over the next decade as the traditional US system is displaced by the healthcare exchange system. While consumers grapple with finding affordable coverage options and providers adjust to the new norms, there is another wrinkle in the mix. In January, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced the agency's push toward value-based and alternative reimbursement models.
Management of Care Case Study Josepha is working on a medical surgical unit with three other RNs and one LPN. There is also a male and a female patient care tech. Josepha has been a nurse for four months, and after completing two months of orientation she takes a full assignment as a registered nurse. Josepha feels that the assignments she receives are not always fair, as she tends to get the most challenging clients.
Enteral Tube Feeding and Severe Dementia Medicare covers many healthcare related services such as inpatient hospital stays, certain skilled nursing services in the long term care facilities, and hospice care for terminally ill beneficiaries or post-acute cares in home settings. Medicare coverage helps many beneficiaries to receive healthcare services that they require to live healthier lives through preventive wellness services as well as medical treatments that save lives. For example, a gastrostomy tube insertion benefits a patient with dysphagia related to an acute medical condition to rehab and regain independence to live a quality life. The gastrostomy tube enables the beneficiary to receive necessary nutrition and rehab to regain swallowing ability. Otherwise the beneficiary is at risk for many life threatening medical conditions such as aspiration pneumonia, or malnutrition.
In 2001 Centers for Medicare & Medicaid was created and replaced the Health Care Financing Administration. The Centers for Medicare & Medicaid manages various programs. They include Medicare, Medicare Part D, Medicaid, Children Health Insurance, and Medicare Advantage. They also authorize different tasks within HIPAA that concern over a million healthcare providers and suppliers. The CMS influence healthcare quality measure which the President, Department of Health and Human Services, and the Centers for Medicare & Medicaid Services have ranked this as a high priority.
Many uninformed individuals believe that Medicare is only a single program, this is a common mistake. Medicare is actually three different programs. Medicare Part A, the first program, financed by payroll taxes offers coverage of inpatient hospital costs and some of the costs of long-term care for the elderly. Medicare Part B covers the costs of both physician expenditures and outpatient hospital services. Part B, different from that of Part A, is financed through enrollee premiums and the general revenues of the government.
Medicare has four fundamental components that are called Parts A, B, C, and D. Medicare Part A covers necessary medical treatments that are performed in a hospital, short stays in nursing homes for rehabilitation, and hospice. Part A receives funding through employers and workers who pay social security taxes. Medicare Part B covers outpatient services that are not covered under Part A such as X-rays and chemotherapy. Medicare Part C is also known as Medicare Advantage, and it offers more benefits and lower costs than Parts A and B through private insurance companies. Medicare Part D covers prescription drugs and has been an option since the Medicare Modernization Act of 2003 that went into effect in 2006.
You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans. Based on the above scenario, answer the following questions: • What effects would join an MCO have your clinic regarding staffing, patient volume, and financial stability?
The Effects of Regulations on Managed Care and IDS Managed Care is a health care delivery system organized to manage cost. The legal and business imperatives of managed care pervade our national healthcare system, the regulation of managed care depends on who contributes to the plan and who bears the risk for paying for the insured services. More than 170 million Americans receive health care coverage or benefits through some type of "managed care" setting.1 By 2007 about 20 percent of these services are directly provided by a health maintenance organization (HMO), while the majority are served through other managed arrangements, 60 percent in Preferred Provider Organizations (PPO) and 13 percent in Point of Service (POS) plans. Beginning
I think it’s wrong for the government to penalize physicians for not meeting compliance standards. However, It’s a great opportunity for the government to aim at small practices because this is where physicians are self-employed. These types of physicians have numerous clinic or health care facilities and are most likely to commit fraud. This seems kind of biased, but it’s true. According to, Ornstein, the most common sanctions are against physicians who have odd Medicare billing reputations (2014, title).
I enjoyed reading your discussion post and I find it very informative. Medicare is an insurance plan provided by federal government for persons who are age 65 and older, totally disabled, and someone with end-stage renal disease (Touhy & Jett 2012). Your patient interestingly brought up some great points about medicare. It is sad to know that retired people have to deal with the financial hurdle of medicare. It can be very disappointing, because of the added premiums and uncovered medical bills.
There are four main components to Medicare. Part A of Medicare deals with the reimbursement of institutional providers for hospital stats or services, post hospital stays, home health, and hospice benefits (Esdin 5). Part B is an elective portion that the majority of those qualified for Medicare elect to have. This portion is not free and requires 20 percent reimbursement. Those selecting part B need to pay a monthly premium for service.
Medicare was initially formed as a health insurance program to provide aid in medical expenses for the elderly. President Lyndon B. Johnson influenced the path of these Medicare and Medicaid programs during his term as president in 1965. During the time that Ronald Reagan was president, new Medicare cost control approaches for health care providers emerged, which aided determining reasonable charges for the services provided and payment options. Medicare and Medicaid were the establishment of a mainstream model of federal medical assistance to people who are unable to secure it for themselves. Over time, many different policies have been endorsed to provide access to health care for specific groups who may be unable to pay for their own medical
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