Medicare Coverage Analysis

This is a follow-up email in reference to a fax issue for Paula Carr's AARP Medicare Supplement application. The application has been forwarded to the AARP Medicare Supplement Department via fax at 888-836-3985 to be scanned for processing. The status may be reviewed within unitedhealthproducers.com in the Application & Enrollment

Quality physician documentation is not only essential to providing superior clinical communication, but also allows for the delivery of useful data that “supports quality metrics, acuity of care, billing, and accurate representation of medical conditions” (Rosenbaum et al., 2014). The Centers for Medicare and Medicaid Services (CMS) uses a system to classify Medicare patient’s hospital stays into various groups in order to facilitate payment of services called Medicare Severity-Diagnosis Related Group (MS-DRG). Some payers also use all patient refined (APR)-DRG reimbursement systems. MS-DRG groups are outlined by a specific collection of patient characteristics which include areas specific to the “principle diagnosis, specific secondary diagnoses,

They review claims before Medicare pays the physician, and an analysis of claims after repayment. They identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of healthcare services. Every practice should be prepared to be audited at some point. The auditor basically goes around to see if any fraud is being committed. There are different kinds of audits such as Recovery Audit Contractor, Certified Error Rate Testing, and Probe Audits. Some things you can do to prepare your staff is avoid coding mistakes, accurately document patient charts, perform random mock audits, prepare implement policies and procedures, and review audited claims. I should also educate my staff the importance

The main reason behind the Medicare Plan F is so liked is that it will wage for all of the gaps in the Primary Medicare Part A as well as the Part B, comprising both of your hospital as well as the outpatient amount. It even wages the 20% that Medicare Part B does not covert. If you own a Medigap F policy, then though, all of these would be paying for with your insurance. So choosing the best company that fulfill your requirements will be your first step. Then you will be able to get the best plan among all other.

The Affordable Care Act (ACA) was signed on March 23, 2010 by President Barack Obama. The enactment of the ACA accounted for medical reform throughout the United States (Osmonbekov, Yordy, & Gregory, 2014). The provisions of document were all geared towards enhancing healthcare by lowering the costs, creating new consumer protections as well as improving access to care. Some of the provisions include section 2706 which establishes nondiscrimination in healthcare. Further, section 4001 provides national prevention, public health council, health promotion as well as an advisory group on prevention and integrative medical issues. The above provisions affect acupuncture practitioners in various ways.

minister and head leader of the Australian government. She received a seat in the house of representative in 1998 and won a seat of labor in the federal election in Australia. After the election in 2001 Ms. Gillard became a member of Shadow Cabinet. While Gillard was still in office, Australia experienced the global economic crisis that peaked in 2007-2008 exceeding any other industrialized countries. During this time frame the Rudd Administration suffered a number of legislative setback leading to the poll numbers for prime ministers. After being elected Ms. Gillard negotiated a comprised agreement with the mining companies which reduce the proposed tax from forty percent to 30 percent. Ms. Gillard is impacting global society through promotion

Recommendation for the author is to provide further proof that the techniques practiced to reduce spending remain the best methods and that it did not have any bearing on consumers who heavily relies on the program. The reason is that most Medicare users are either people over the age of 65 or people with disabilities. Reduce Medicare spending might be helpful, but if it is not benefiting the consumers, it serves, the interest becomes unwarranted. After all, Medicare covers only eighty percent of consumer’s medical expenses, leaving users with twenty percent cost of medical bills. Nevertheless, I would suggest the author to report on consumers and healthcare practitioners’ feedback regarding the finance cuts by CMS.

As you mentioned, the ACA has changed the way hospitals receive reimbursements from volume to valued-based incentive system. I learned that a percentage of Medicare reimbursement will be withheld unless hospitals meet benchmark performance measures in outcomes and patient satisfaction. Healthcare analysts are emphasizing that for hospitals to achieve the quality outcomes, a focus on assuring reliable measures, use of evidence-based practice, and skill in care coordination is needed (Jeffers & Astroth, 2013). A shift in the system will require care providers to have a patient-centered focus and experience in team care delivery. Jeffers and Astroth (2013) believe that graduate preparation and an advanced nursing degree are needed to prepare

Medicare Supplement Insurance is a great option that provides additional health insurance benefits for people 65 years old and over already on Medicare. When a person turns 65, he or she can automatically receive the benefits of Medicare. Medicare supplement insurance programs take that healthcare to the next level, especially covering expenses Medicare may not cover.

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

Obamacare refers to an Affordable Care Act (Archambault, 2014) in the U.S healthcare reform law which expands and improves the access to care services and reduces spending via taxes and legislations. The main focus of Obamacare is to provide more Americans with affordable access to health insurance and improve on the health care quality and health insurance in the nation. It regulates the health insurance industry hence reducing healthcare spending in the United Sates. The law features various provisions of the healthcare crisis aspect in the country. The affordable Care Act does many important things such as offering U.S citizens with rights, new benefits, and protectionism in relation to their healthcare. It sets up a health insurance marketplace where Americans can buy federally subsidized and regulated health insurance. Obamacare expands on Medicaid to U.S adults in many of its states. It also improves Medicare for the senior population and those with long-term disabilities. Every year during the annual open enrollment period, U.S citizens can access health insurance coverage using the health insurance market place.

Thought Medicare and Medicaid are both government created and government funded programs they are very different and have very distinct requirements for eligibility. Medicare is designed to help the elderly and disabled get treatment through a long period of time. It consists of four parts: Part A: Hospital coverage, Part B: Medical coverage, Part C: Private coverage, Part D: Prescription drug coverage. Medicaid is very strict on regulations for benefits eligibility. This is a coverage help from the government that is designed to help cover medically necessary treatments/checkups for individuals that have low income. There are certain requirements to this specific plan and there can be many different companies that are Medicaid affiliated.

“For some middle-income Americans, the subsidies available for buying Obamacare policies are not generous enough and the fines for not having coverage are too small to encourage them to enroll in plans” (BBC,2016). This explains the current situation of millions of Americans across the country. Many have been opposed to Obamacare or the Affordable Health Care Act (ACA) because it isn’t as cost effective as it was promised to be in 2010. The low number of enrollment is the key reason for the cost of health care going up. When the Act was proposed the government and health insurers expected all of the uninsured people to avoid paying the fines and to sign up for health care. This would force people who voluntarily declined health care for personal

The origin of the Affordable Care Act (ACA) spans prior to 2010. In the late 1980’s and early 1990’s, universal healthcare was an interest in the United States. In 1993, First Lady Hilary Clinton discussed the Health Equity and Access Reform Today Act of 1993 as a proposal for universal health insurance for every citizen (Mertens, 2010). It was later killed by special interest groups before taking off in congress and deemed too complex (Cohn, 1994). Since President and First Lady Clinton proposal, various members of congress attempted other alternatives to the universal healthcare.

Furthermore, utilizing my biology degree, as a stem, with clinical research experience in diverse therapeutic areas, I have become well versed in conduction in-depth research, assisting Principal Investigators with researching trends and outlier related to subject data to help decide the best plan of action for each study. I am adept in AE and SAE reporting, GCP compliance, and subject screening protocols. Moreover, while my on-the-job experience has afford me a well-rounded skill set, including communication and organization skills, in order to execute multiple studies.