Medicaid Case Summary

Epic is a single integrated system for the clinical and business functions of health care provision that include registration, scheduling, and billing. The system is owned by Epic Systems, formerly Episodic Care, a large provider of HIT (health information technology) and is mainly utilized by health providers in accessing, systematizing, storing, and distributing EMR’s. Epic Systems is an independent firm in Verona, Wisconsin with a vast campus. Epic is useful in streamlining regulatory compliance, clinical workflow, quality care, the patient experience, and clinical documentation. This is a reflection of the

In this research paper it will identify how Medicaid came about and what Medicaid used for, the different between Medicare and Medicaid, the benefits and disadvantage in the use of Medicaid. Medicaid is a state administrated program that provides medical support for a broad range of people. Medicaid was established in 1965 through the Social Security Act, which was an act to provide for the general welfare by creating a system of senior citizen benefits as well as low income people not all but limited to and by enabling that many states to make more acceptable provision for aged people, blind, dependent and crippled children, maternal and child welfare, and public health. Medicaid program was one of many programs created to

In the state of Texas Medicaid is funded by state and federal programs. Those eligible to receive Medicare benefit is the low income individuals, families, children, pregnant women, elderly and individuals who suffer with disabilities (Hegar). The Texas Health and Human Service commission (HHSC) distributes the Medicaid (Hegar). Those receiving Medicaid benefits in the fiscal year of 2010 were found to be 55 percent female and 77 percent under the age of 21 (Hegar). Children accounted for 66 percent of all Texas Medicaid recipients in that year; however, 32 percent of those children actually received health care (Hegar).

After reading the Just The Facts excerpt and the case of McDowell V. Krawchison, I would have to say that I believe this employer violated COBRA. It is stated in the textbook that, “The COBRA requires that employers who have group health insurance plans and at least twenty employees offer continuation coverage to employees (and other beneficiaries if there is family coverage) who experience qualifying events that would otherwise cause the loss of their health insurance.” (Walsh, Pg. 486).

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

Medicaid expansion is seen as a huge problem in this case it takes place among the 50 states. The environment includes the 50 states such as California, Texas, New York and New Jersey. Medicaid expansion offers financial protection. It also addresses the uncompensated care problem which involves paying and reimbursement for service rendered. Medicaid expansion also provides customers access to affordable coverage, as well as customers taking up that cover, which is a moral duty of the government. Medicaid also supports politically powerful interest groups who support expansion. The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under

"We don't believe it’s right and we know it's going to basically bankrupt the states."(Hensley 2012) quote given from Texas Governor Rick Perry about Medicaid expanding in Texas. The Medicaid expansion "would simply enlarge a broken system that is already financially unsustainable," he wrote. "Expanding it as the PPACA provides would only exacerbate the failure of the current system, and would threaten even Texas with financial ruin." (Hensley 2012). Texas is among the twenty-two states that did not expand Medicaid, and for good reason at that.

The decision to reject Medicaid expansion by the former and current governors of Texas has left at least one million low-income earning nonelderly adults Texans uninsured resulting in the loss of several millions of dollars in uncompensated health care services extended to this vulnerable demographic, coupled with high insurance premiums (Mangan, 2015) which begs for the expedient conception and implementation of a statewide solution to address this unsustainable economic burden and create a more healthy, and productive society in the great state of

A Spanish-speaking member of Kentucky medicaid called in to the call center where I working in Louisville, KY. She quickly started to talk, she sounded very afraid. she was crying and begging me not to cancel her childrens medicaid. Once there was a pause I quickly stepped in and comforted her by telling her that I am here to help her the best way I can. She was acting this way because she receive a letter from the state and assumed they were going to cancel her kids medicaid because she missed an appointment, she didn't understand the letter very well and couldn't translate it for me but she did mention the name of our company was on the letter. I had an idea of what is what about but just to be 100% I asked the customer if it was not too

Medicaid fraud, regardless of who perpetrates the fraud, is misrepresenting information to obtain a benefit from Medicaid. Both the state and federal government have programs to identify and prosecute Medicaid fraud, although, currently, the emphasis is on fraud prevention. Because fraud cost the Medicaid billions of dollars each year, these programs have become sophisticated; New York routinely checks DMV records, bank accounts and other data to discover potential fraud. Whistleblowers also receive money for reporting Medicaid fraud. Everyone who participates, in any way, in the Medicaid program may be charged with fraud including:

The testimony given for the Medicaid at 50: Strengthening and Sustaining the Program (Medicaid at 50) begins with Chairman Joseph R. Pitts, representative from Pennsylvania, giving basic information regarding Medicaid, the current status of the program, and the future. Chairman Pitts lays out the basic issue at hand, the growing expense of Medicaid and that currently there are more individuals enrolled in Medicaid than Medicare and those growing numbers are requiring states to make difficult decisions regarding sustainability for the program both at the state and the federal level. In order to address and provide answers, the panel was composed of two women from the Center for Medicare and Medicaid Services and one from the Government Accountability Office.

The date of service should never be change. In order for the insurance to pay (if they accept to do it), billing should re-submit the claim with the information about that office visit. Medicare usually has a retroactive effective date for Part B premiums, which can be deducted from the lump sum of the SSDI. In some cases, then there may be Medicaid eligibility for a period of time and again, any services obtained during that time could be paid by Medicaid. If Nancy takes a chance and change the date and this action is made, it can lead to an investigation under Medicare Fraud. Medicare claims must be filed no later than 12 months after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't

The Medicaid expansion and hospital readmissions are applicable to my organization. It has influenced my organization to partner community based housing programs for our members. Hennepin Health plan network is setup for our members attend Hennepin County Medical Center, and (HCMC) HC clinics. As a result, we were able to capture emergency room frequent users in a timely manner. For example, we have Community Health Workers and Case Managers at HCMC and HC clinics, so if high utilizers of emergency room (ER) member is in the community health work and case managers can complete an assessment to determine their social and health needs. In many cases, a portion of their medical benefits will pay for their housing, due to increased high hospital

Sometimes before you know it you are trouble with Medicaid. When this happens, you need to have a lawyer to represent your interests. By the time you get the letter stating that you have committed Medicaid fraud, they already have all the information that is needed in order to indict you on criminal charges. You do not need to go into this alone. You need someone experienced in these types of cases. You need an experienced Medicaid fraud lawyer. A lawyer understands all the aspects of a fraud case and will be able to explain it all to you. If you go into his alone, you may find yourself in prison with a huge debt. A lawyer will help keep this from happening. While you may still have to do prison time and pay a fine the time in prison will

This study will provide an in depth analysis of the Medicaid Case study using the Burke-Litwin Model. In light of this, it will provide key insights and understanding on the relevance of organizational change and transformation while examining the 12 key areas of the model. In addition, the study will compare the model with organizational model including Nadler-Tushman and McKinsey 7-S Models as well as address some of the limitations of the Burke-Litwin Model in relation to the Medicaid Case.