Medicare Case Study

The Medicare and Medicaid programs were signed into law on July 30, 1965 by president, Lyndon Baines Johnson. The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services in charge of administration of several key federal health care programs. CMS is responsible for health care programs such as, the Health Insurance Portability and Accountability Act (HIPAA), the Clinical Laboratory Improvement Amendments (CLIA), and the Children’s Health Program (CHIP) amongst other services.

2 Certain persons in Florida are eligible for Medicaid. Please post a synopsis of this program. Be sure to include the following:

I sent the forms to the member on 06/06/2016 as per request but she doesn’t want to fill them out. She went to the Medicaid office (115 Chrystie St., NY, NY 10002) on Wednesday June 8,2016 and they informed that her case is being handle and not further documentation is needed. Medicaid Office gave this case # 0237738221E. That’s the reason why she doesn’t want to fill out further documentation.

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.

On this date worker received a call from Ms. Kimbrell, Medicaid Caseworker. Ms. Kimbrell stated Mr. Duncan's nephew who is living at the residence in Curry would need to fill out a Statement from Dependent Relative/Community Spouse form. Because he is living in a home, Mr. Duncan is part owner. She also stated Mr. Duncan would be denied institutional Medicaid because he was not transferred to a long-term facility. However, he could receive hospital Medicaid because he was in the hospital longer than 30 days. The transfer penalty does not apply to hospital Medicaid but if Mr. Duncan ever applies for institutional Medicaid, they would need the person who purchased the home from Mr. Duncan to provide something showing the amount of money he spent

Both the Medicare and Medicaid programs are under the U.S Department of Health and Human Services administered by the Centers for Medicare and Medicaid Services. Under Medicare part A there is no premium if the beneficiary is eligible for Medicare.

On June 28, 2012, the United States Supreme Court issued a decision that made the enforcement mechanism for the ACA Medicaid expansion optional for states. Regardless of that decision, the Affordable Care Act (ACA) has reduced the uninsured rate since its complete implementation in 2014. The original intent and projections were that all states were expected to expand Medicaid. However, after that Supreme Court decision, some states chose not to expand Medicaid.

I enjoyed your post. I never knew about Medicare Part D and I'm not sure why. Medicare Part D built the biggest addition and changes to Medicare in 2003 (Niles,2015). This program receives most of the funds from the federal government through tax revenues. The main purpose of this program was to provide aid for the costly price for prescription drugs for seniors. Like you mentioned, this is a voluntary program to enroll in and requires premiums. Additionally, Medicare part C has Medicare Part D already included in the benefits. The benefits of Part D include affordable prescription plans for those enrolled in Medicare Advantage, traditional Medicare health plan, and for low-income seniors (Niles, 2015). The Medicare Prescription Drug

“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 supplement insurance supplements or completes the Medicare plan. If you are 65 or just about to turn 65 or you find yourself disabled for a period of 24 months, it may be that you qualify for benefits from Medicare. Medicare is the government run health insurance program intended to provide coverage for individuals who have been disabled as well as older citizens. The only trouble with Medicare is it does not pay for the entire cost of your medical expenses. There is always about 20% left over for the individual to pay out of their own pockets. That could be a problem for those on fixed or low incomes.

We receive a payment for Medicare on the new Trizetto account and when I check the EOB the payments are for the 4 first claims submittion that you guys post and send from Cerner .Medicare pay 3 patients only. My question is Do you want me to post the Medicare EOB on Cerner? or Do you want to posted ? I just ask b/c I don't know if you have a different plans on How or Who will be posting the payments on the new system. Please advise.

Thank you for your letter of 06/28/17 in which you demand $50,000.00 for a Section 32 settlement of the matter subject to a Medicare set-aside.

The referral system enacted between the physicians termed “ping-ponging”, is problematic. Such a problem can be classified as a crisis; crisis problem solving is instantaneous and addresses a present threat. In this case, failing to act promptly will cause untoward results, such as a decline in near-term performance (298). The financial performance of the hospital has begun to feel the negative effects of the physician's acquired referral system. The hospital has experienced above-average denials for Medicare reimbursements (320). As the case suggests, most of the patients are older, therefore, the likelihood of them having Medicare is high; a decrease in Medicare reimbursements can have catastrophic financial consequences.

An AEP treating Medicare patients have the choice to either bulk bill patients or set their own fee for service rates. If the AEP chooses to bulk bill, Medicare publishes claim slips that can be used for the bulk billing of patients. If a fee is set and a gap payment is required to be paid by the patient directly to the AEP, an invoice is required to be provided to a patient for the services with all specific information for clients to they can claim back the amount from Medicare. The invoice used by the patient to claim back the rebate amount from Medicare must include: Patient name and details including Medicare number; Partitioners name and either: address of the place of practice from which services was provided or provider number for

Providing quality delivery care is the cornerstone of Kaiser operation and addressing language needs of the diverse communities it serves is receiving attention from the National Diversity and Inclusion Office. Kaiser’s National Diversity and Inclusion was established with the objective to promote, support, and assist the regions in implementing the Kaiser Permanente Board of Directors agenda in providing culturally competent medical care and culturally appropriate services to improve the health and satisfaction of its members.