Case Study: Forever Cushion

Medicare will pay for some of the cost for 100 days. First 20 days they pay the full amount and from 21 days to 100 the individual pays $140 of expenses.

According to Newsweek, the University Medical Center on average has about $100,000 dollars a month in unpaid doctor’s visits and operations and special procedures; this burden gets passed on to the County taxpayer (Johnson). Unpaid bills occur due to people taken to the hospital and either do not have, or have very poor health insurance. The current process is not fair to anyone, whether one has no health insurance or one who has paid for it. Under the Patient Protection and Affordable Care Act, otherwise referred to as Obamacare, signed into law on March 23, 2010, this requires all Americans to purchase health insurance. The purchase of this care is purchased either individually or through the government market place. The act will lower

The Quality and Health Outcomes Division together with the Long Term Care Administration drafted a SPA amendment on the Stevie Sellows section of the existing SPA. The amendment was needed because the existing SPA was very difficult to implement, to monitor and to measure its impact on the quality improvement of the provider. In addition, providers are expected to spend funds on quality improvement initiatives without any guarantee of them getting reimbursed to cover their expenses. Having noted the above stated problem, they drafted a new draft amendment that will entirely replace the existing section of the SPA that deals with the Stevie Sellows funds.

In an attempt to keep your medical cost for services to a minimum, we have adopted the following policy regarding payments and billing. If you do not have insurance coverage, payment will be due in full amount on the day the service is giving.

Thank you in advance for your prompt response and guidance. It has been 4 months and 10 days since our loss occurred, we sit here gathering paperwork, typing up emails, making endless phone calls, having to suffer the very circumstances we assumed we were insured

“I’m so sorry Mrs. Jones, but your insurance doesn’t cover that.” My mother stood, staring in disbelief at the $850 invoice that she received for her C-Pap machine. She had no clue how she was going to pay for it since her only income is her monthly social security disability disbursement, which is only $850. She desperately needed this machine for her Sleep Apnea but how would she afford this when she has so many other expenses? Why isn’t Medicare covering the cost of this machine? They covered the hospital stay that led to the diagnosis, so why not this? This scenario and similar ones present themselves far too frequently. As a solution, let’s discuss the basics.

Medicare Part A hospital insurance is normally provided for free of charge to individuals, whose ages are 65 and older or have a disability. Each benefit period begins the day Medicare beneficiaries are admitted to the hospital and ends when those individuals have not been hospitalized for a period of 60 consecutive days. When Medicare beneficiaries are first admitted to the hospital, they pay an initial deductible of $1316. From the 61st through the 90th day, they are responsible for a copay amount of $329 per day. After the 90th day, they will pay $658 per day for 60 additional lifetime reserve days or can opt to pay the 100percent of charge and continue to reserve the 60 lifetime days. If there are more than 60 days between a discharge and a following readmission, a new benefit period starts with the same $1316 deductible and coinsurance. Moreover, Medicare beneficiaries may be eligible for skilled nursing facility benefits after being hospitalized for more than 3 days and when the skilled nursing facility admission begins within 30 days of the hospital discharge. In that case, the beneficiaries owe nothing for the first 20 days and are responsible for $144.50 per day from day 21st to day 80th. The beneficiaries are obligated to pay all cost after 100 days. Home health services are covered 100percent by Medicare if beneficiaries are confined at home; however, they have a 20percent

Traditionally the American health care system relied heavily a repayment model referred to as fee-for-service which is described as a form of repayment that generates a greater emphasis on the volume of patients seen rather than healthy outcomes produced under a physician’s care. The fee-for-service repayment method poses multiple issues such as: duplicating services which in turn renders some of the services unnecessary, utilization of expensive technology because of the revenue generation rather than as a valuable diagnostic tool and crowding caseloads to an unmanageable level in order to achieve highest level of reimbursement. The aforementioned events not only have the possibility of being unethical but also drive up the cost of health care in the United States. Currently, health care costs have not only increased, but the Office of the Actuary projected that U.S. healthcare spending will make up nearly 20 percent of the economy in 2019. One would argue that if as a country we are spending so much on health care that we should be a “healthier” nation, but this is not the case. Even though America continues to be the largest spender on health care, collectively we experience a lower life expectancy rate compared to other industrialized countries (hfma.com, 2011, p. 2). To assist with climbing health care rates healthcare purchasers have called for repayment reform. One such reform that has been on the forefront is Value-Based Health Care (VBH), also known as outcome

In ruling that the patient bears the burden of payment because no membership existed, the Department’s decision exemplified a referendum on fiscal responsibility rather than concluding on the validity of the charge. Determining responsibility for payment assumes the assignment of a valid charge, which does not exist, and eliminates the health plan. When health providers cannot provide concrete evidence to substantiate a medical invoice charge and/or lack the proper specificity to either accurately identify or describe a charge, it should not be incumbent upon the patient to bear the burden of such gaps in the basic management of internal

The claimant has a 55% schedule loss of use of the right leg. There is no permanency to the back.

The only explanatory bill is the Radiology Associates, because I can confirm that those where the only meaningful service offered. On the other hand, I am furious as to the reason why I should pay MD Emerg Med Netwk: $789. There is no reason why a doctor should have a face to face with a patient without a knowledgeable information and demand such a ridiculous pay. I personally think this is a reap-off, because I did not receive

The Affordable Care Act has changed the way hospitals are reimbursed. Although hospital charges are federally regulated all payments do not correspond, and payments may vary greatly depending on the patient’s insurance.

Our billing process begins with you registering as a patient, in the registration packet we will need accurate demographic information and insurance information. Prior to receiving service, you will also be required to pay your copayment or co-insurance which is simply your percent of the cost you pay. After your information and payment have been gathered you will then receive your service. All services receive while in our care will be documented to ensure that you and your insurance company receives an

The Centers for Medicare & Medicaid Services (CMS) was made headlines by releasing charge and Inpatient Prospective Payment System (IPPS) installment data at the MS-DRG level for hospitals across the country. In spite of the fact that this data has long been openly accessible, having it provided more easily available brought about it by being reported of various media outlets. Tragically, this information discharge was not accompanied by expert information clarifying what the numbers mean, creating an interest for hospital facilities to react, at the end of the day, to forceful request in regards to their charging practices.

I paid my copay and make another appointment with dismay. I now know that there were two barriers that played a part in my dissatisfaction with the appointment. The first barrier was the lack of time I spent with the actual doctor and the second being the lack of attention the doctor paid to me and my injury. If I was a provider I would be sure to spend enough time with the patient and ensure that they feel that they have communicated everything they intended to. The day of my follow-up appointment arrived and I was still not feeling any relief from the pain and my knee was still giving out so the doctor decided that it was time to look into getting an MRI. He felt the area around my knee again and told me that he would call me to let me know how to proceed once he was able to get me approved for an MRI. I paid another copay and left wondering why I had to make an appointment for that in the first place. After waiting a week or so for a call from Deweese, I decided to give them a call and see if I was able to get an MRI. On the phone I was told that my MRI request was denied by my insurance and that I would need to make another appointment to discuss it. I was frustrated because