Medicare Contract: Case Study

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

The Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010, and on June 28, 2012 the Supreme Court decided to uphold the law.¹ Some of the most notable features that the ACA will provide for individuals are access to healthcare for everyone, new consumer protections such as pre-existing condition coverage, free preventative care, protection against healthcare fraud, small business tax credits, as well as many other features.¹

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

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

Conclusion: The Obamacare has its very good points it does benefit the economy in ways that are meant to take the economy out of debt. But they do cause side effects that may not have been thought of.

“Our founders got it right when they wrote in the Declaration of Independence that our rights come from nature and nature’s GOD, not from government.” says Paul Ryan, who at the time was running for Vice President of the United States with Mitt Romney in 2012. Paul Davis Ryan Jr, who currently serves as the 54th Speaker or Representative and also represents Wisconsin’s First Congressional District, has had many plans and accomplishments since winning his first election to the house in 1998. In this paper I will be discussing Paul Ryan 's plans for the future of health insurance, his work with current President Donald Trump and his accomplishments during his terms. I will also be talking about my opinion for Ryan’s future plans for America.

On viewing this video “The Story of Medicare” I was able to understand that the role of Medicare(MR) and Medicaid (MD) centers is to cover all people over the age of 65 or older regardless of their income, health status or residence. Medicare also provides benefits for people of any age that have certain disabilities. MR & MD services is a program that allows low-income families whether healthy or sick to receive health care coverage. Medicare has successfully increased the life expectancy of Americans over decades as before Medicare coverage, the life expectancy of white Americans was 61 years and black Americans 48. This number has increased for both white and black Americans adding 15+ years of life expectancy. I believe that Lindon B. Johnson

With the Advent of the Affordable Care Act, came many changes throughout the medical industry, changes happened in hospitals, health insurance, and doctors. Doctors, more than any other group seem to be affected in a number of way, from the amount of patients, from the increased number of people with insurance plans. It also changed the way a doctor interacts with other parts of medicine. There are some questions arising from this such as; would doctors approve or disapprove of these changes along with do these changes affect the doctors' ability to practice. For the most part, there is no difference the way doctors practice or to their income, but it does have doctors utilize their abilities towards medicine rather paper pushing which could have doctors prefer the post-ACA medical community rather than before.

HCA is a healthcare provider that was established in 1968. Their main focus is on offering cliental with a number of different services to include: inpatient, intensive care, outpatient, diagnostic and emergency services. To achieve these objectives they operate a variety of facilities such as: outpatient, psychiatric, surgery centers, freestanding emergency care facilities, diagnostic / imaging centers and comprehensive rehabilitation / physical therapy centers. They are structured to create increasing earnings for its policy and shareholders. This is achieved by contracting with private doctors to deliver services to its preferred providers members. At the same time, they receive fees from these entities and they negotiate lower group rates.

Government programs, such as Medicare and Medicaid are designed to provide assistance to individuals outside of what the market provides. For instance, Medicare provides coverage to over sixty-million elderly and disable individuals in the United States (Medicare, 2015). One advantage of Medicare is that Part D, also know as the “doughnut hole”, is expected to decrease by 2020. In short, this is “where beneficiaries had to pay 100% of their costs until they reached the catastrophic coverage level” (Medicare, 2015). On the other hand, Medicare does not cover hearing aids, vision, or dental services; nor does it pay for “long term services and support such as extended stays in a nursing home” (Medicare, 2015). This is extremely counterproductive

The Affordable Care Act expands access to health care coverage and reforms the health insurance, marketplace (Virginia Senate Finance Committee, 2012). The law gives states the choice to expand Medicaid for any individual whose income falls below 138 percent of poverty. In the state of Virginia, there are approximately 1 million uninsured residents. This is often caused by lack of insurance through employer and inability to pay the premiums if offered. According to the Kaiser family foundation, The Virginia’s Governor has included Medicaid expansion as part of his FY 2017 budget proposal. The overall cost to expand Medicaid in Virginia would likely be $220 million beginning in 2016-2018 biennial budgets not including administrator cost. The

Part D decreases their out of pocket expenses for prescription drugs for a lot of people. Therefore, a great decrease is recognized by patients with extremely high annual expenses for prescription medication. Though, Part D cost patients with low income more then what they previously paid to its adoption when state Medicaid programs covered them. The legislation that established Part D forbids Medicare from negotiating lower prices with drug manufacturers. As a result of an increase in costs of prescription medications frequently passed to the benefit recipients (Mathews, 2006). The legislation are groups that influenced the final outcome of Medicare Part D.

There is no standard Revenue Cycle billing process to ensure claims are accurately and compliantly billed to Medicare for inpatient stays of two days or less. Four of the 10 sample claims were non-compliant with the Two-Midnight Rule.

Do you have some durable medical equipment, prosthetics, orthodics or associated supplies (DMEPOS) in your medical office supplied by a home medical equipment (HME) supplier? Such an arrangement is often called a loan or consignment closet.

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.