Medicare Case Study Summary

Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s.

Increased evidence demonstrates APRN’s provide equivalent quality of patient care as physician and have excellent patient satisfactions scores (Hooker & Muchow, 2015). All the while, APRN’s bill at a lower rate. Hooker and Muchow (2015) state the use of APRN’s can result in a 20% in costs resulting in hundreds of millions of savings.

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

We've had some major news stories about MA Plans overcharging lately. What exactly are they about?

I have to include this for the sake of completeness. Most people know what Medicare is because they have been paying into it for years. This is something you will qualify for when you turn 65. The main thing to be said about Medicare is that it is the best deal for senior around, so you need to sign up for it as soon as you become eligible. Also, during the enrollment period, you need to consider buying a supplemental insurance policy. Medicare only pays approximately 80% of your medical bills. A good supplemental policy will help pay much of the rest of the bill. If you are too poor to buy a supplemental policy, you may qualify for Medicaid. If you are currently enrolled in Medicare, it is possible to use Medicaid as supplemental

The year 2017, you will notice a change moving on into place for the healthcare. If you

Veteris Health, LLC is a healthcare company specializing in the care of elderly Medicare patients. Although its headquarters is located in Cleveland, Ohio, it serves elderly people across the nation. Veteris Health contracts with Medicare health insurance providers and provider networks across the United States to provide extensive in-home health assessments of the Medicare insurance providers’ clients at no cost to the patient. The assessment consists of everything from seeing how the person is living in their domicile, to what prescription drugs they are taking, and a comprehensive physical exam. This is to provide innovative healthcare solutions to improve health and quality of life of the elderly.

Medicare is one of the major financing sources for healthcare since 1965. Hospital Insurance or Medicare Part A is funded 1.45% from employee payroll tax and 1.45% from employer on all revenue. Self-employed individuals pay 2.9% of income. The government support nearly 75% of Medicare Part B and the other 25% is paid by individual’s monthly premiums. Medicare Part B individuals will be covered 100% once their $147 deductible is met. (Shi, L., & Singh, D. A., 2015)

A large study (10,911 patients) showed that APRNs demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction and cost. The study concluded that there were no significant differences in primary care provided by APRNs vs physicians; and actually in some parameters APRNs care was superior. While studies are needed to assess longer term outcomes, these data suggest that the APRNs workforce is well-positioned to provide safe and effective primary care (Swan, Ferguson, Chang, Larson, & Smaldone,

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.

There are a number of cases that have been tried for fraud and abuse here are a few examples: There was a $6.35 million fraud settlement at Robert Wood Johnson University Hospital Hamilton, NJ. In Sacramento the was a five physicians team that a grand jury indicted in June for running an alleged Medicare fraud scheme worth $5 million. And a Michigan Neurologist was accused of falsely diagnosed seven patients to increase test volumes. All seven were healthy patients so there was a lawsuit but the hospital insisted that his compensation was not due to

This is a follow-up email in reference to your question for Authorized to Offer Medicare Supplement plans.

Medicare is currently facing challenges when it comes to making healthcare affordable for all. Even though this program was design to protect the elderly from financial hardship due to medical care, the cost of health care still affects those with low incomes and serious illnesses. Also, the rise of health care cost has not only affected the health care system, but also Medicare. It is said that insures base their pricing off of number of healthy individuals. What Clinton is trying to do is increase the number of healthy people in the Medicare population by increasing the number of people younger than 65. Since the amount of people between the ages of 55 and 64 are larger, Clintons hypothesis is that the amount of healthy individuals should

Josh Sutter and his wife Elizabeth call to enroll in a Medicare Advantage plan. They have just lost employer coverage with Elizabeth’s job since she just turned 65 and has retired. Agent Nancy Prigge verifies HIPAA compliantly with both Josh and Elizabeth, who are on speaker phone. Nancy goes on to ask for the couple’s PCP. Josh states he sees Dr. Kristina Anderson and Elizabeth states she’s a patient of Dr. Dennis Patton.

The Medicare system has contributed various positive aspects towards the Australian health care system. These aspects include free public health services for permanent residence, benefits and rebates for medical services listed under the Medicare Benefit Schedule, pharmaceutical subsidies on prescription medication and free treatment in a public hospital. Moreover, data constructed by Bloomberg (cited in Tasker, 2015) stated that Australia ranks eighth out of fifty- five countries for the most efficient health care due to the positive factors that attributed from the Medicare system.