Medicare Part A Case Study

is admitted to is Medicare certified, Medicare Part A will pay for 100% of her

Medicare part A is hospital coverage for inpatient hospital stays. More specifically, Part A is coverage for critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. Part A also covers inpatient care in a skilled nursing facility (not supervisory or long-term care), hospice care services and some home health care services. Inpatient care in a Religious Nonmedical Health Care Institution is also covered. In the scenario provided, Mrs. Zwick is admitted to the hospital as an inpatient because she had a stroke. The patient was deemed by the physician to need continued treatment after discharge due to the patient 's condition and was discharged to a skilled nursing facility.

Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private

In 1965, President Johnson signed Title XIX of the Social Security Amendments, which enacted Medicare and Medicaid (CMS, n.d.). Originally, Medicare was composed of Part A and Part B. Part A is covers more medical costs associated with hospital stays, while Part B cover medical costs such as durable medical equipment, nebulizers, some vaccinations (Pneumovax ®, Zostavax ®, and Flu), and some nebulized breathing treatments. The original program was designed to cover disabled individuals and every over the age of 65.

Part A (Hospital Insurance program) covers inpatient hospital stays, home health service, and skilled nursing facility. In addition to this, Medicare pays for 100 days of care in Medicare-certified skilled nursing facilities as well as for the patients staying in Medicare certified hospice. Some people do not pay any premium for part A due to the taxes paid by them or their spouse during their working years. Moreover, contribution comes to Medicare through payroll taxes paid by individuals which make them eligible for the benefits. In order to become eligible for this premium free Part A program, individuals or their spouse must have forty credits after working at least 10 years. However, people, who do not have forty credits, will pay a monthly

The conference offers workshops that will clarify changes in the new Medicare policies as well as provide information detailing the supplemental insurance policies available to patients. This training offers a wonderful benefit to North Shore because when all care coordinators are educated about the new Medicare policies and can calculate the correct supplemental insurance plans for each patient, coordinators can recover treatment costs for the clinic. While the total cost to attend this conference is $18,000, this amount pales in comparison to the treatment costs that will be recovered due to the education of the clinic’s patient coordinators. Knowledge of the Medicare changes can help coordinators recover, for the clinic, up to or exceeding $50,000, per patient, in some cases. Therefore this one time cost will reap large returns down the

Medicare Part A hospital insurance is normally provided for free of charge to individuals, whose ages are 65 and older or have a disability. Each benefit period begins the day Medicare beneficiaries are admitted to the hospital and ends when those individuals have not been hospitalized for a period of 60 consecutive days. When Medicare beneficiaries are first admitted to the hospital, they pay an initial deductible of $1316. From the 61st through the 90th day, they are responsible for a copay amount of $329 per day. After the 90th day, they will pay $658 per day for 60 additional lifetime reserve days or can opt to pay the 100percent of charge and continue to reserve the 60 lifetime days. If there are more than 60 days between a discharge and a following readmission, a new benefit period starts with the same $1316 deductible and coinsurance. Moreover, Medicare beneficiaries may be eligible for skilled nursing facility benefits after being hospitalized for more than 3 days and when the skilled nursing facility admission begins within 30 days of the hospital discharge. In that case, the beneficiaries owe nothing for the first 20 days and are responsible for $144.50 per day from day 21st to day 80th. The beneficiaries are obligated to pay all cost after 100 days. Home health services are covered 100percent by Medicare if beneficiaries are confined at home; however, they have a 20percent

(also known as Medicare Advantage), is offered by private insurers that covers Part A, Part B

Medicare part A is Hospital Insurance. This means that it covers the costs associated with a hospital visit, such as a room and food (https://www.medicare.gov). Medicare part A is funded by a 2.9% tax split evenly between workers and employers.

There are two types of Medicare. Medicare A provides coverage for hospital costs and Medicare B covers premiums for physician services and supplies. Medicare D is prescription insurance.(Centers for Medicare and Medicaid, (n, d)) Most healthcare insurance cover costs associated with prescription medications, however a co-pay may be required. Criteria for referral to specialists is dependent on health insurance coverage. Health Maintenance Organizations normally require a referral for specialists. Also, services outside of this network must be pre-approved. Referrals required for specialists within a preferred provider organization is dependent on type of specialists. The services in this plan do not include preventive care. Fee for service insurance has a fixed premium percentage and insurers can choose physicians and specialists without a referral. However, insurers are responsible for any above the fee payments.

Recommendations for Medicare Part D include; limiting initial supplies of designated drugs to one month to cut down waste if the individual terminates therapy; a continued supply would be available for subsequent periods. Regulatory changes may permit Part

Medicare part A benefits apply as soon as the patient is admitted to the hospital and end when the patient is hospitalized for 60 consecutive days. After 60 days, the patient will be responsible for copay from 60 days to 90 days. Medicare part A pays for hospital and skilled nursing facilities only when deemed medically necessary. Initial copayment is required upon hospital admittance and separate copayment is required after 60 days within a benefit period. Once the patient pays the copay, the hospital or skilled nurse facility will document all services provided to patient. Coding will assign payment codes to all services rendered for billing purposes. Once all codes are in place and assigned to a service provided, all services will be reviewed and a claim will be filed. A claim cannot be filled until the patient is discharged. A patient can stay a maximum of 100 within a benefit period as long as the patient continues to pay copay after 60 days. Medicare part A only covers inpatient hospital and skilled nursing facilities. Medicare part A does not cover Outpatient services. Medicare part B covers Outpatient services or supplemental services. Physician and surgeon services such as dentists and podiatrist services are reimbursed under Medicare part B coverage. Medicare part B coverage must be documented as medically necessary or medically preventative in order to be covered and reimbursed. Medicare part B usually carries a deductible and only covers outpatient services that

Some of the financing medical care I will be discussing are Medicare, Medicaid, (MediCal), US Department of Veterans Affairs, Indian Health Service, private insurance or out of elders’ pockets (Ferrini). There are four parts of Medicare. Part A is a hospital insurance, Part B is medical insurance, Part C is a private managed plan, and Part D is

In the therapeutic setting, the most common type of managed care is Medicare; this typically covers persons 65 or older who are entitled to a monthly Social Security. These patients must use doctors, clinics, hospital, and specialists that are already in the plan’s network ("Private vs. Public Health Insurance"). While Medicare will provide coverage for both inpatient and outpatient therapy, it also presents the most limited care due to the therapy cap and use of impairment evaluations. The Medicare therapy cap is a predetermined amount of money that patients are allowed to spend to receive services. The cap for 2015 is $1,940 for occupational therapy alone in which the patient pays 20% of the cost and Medicare pays 80% (“Medicare Limits on Therapy Services”). This cap can be potentially troubling for people who have suffered serious injuries such as stroke or traumatic brain injury that may need months of extensive therapy. In addition to the therapy cap, Medicare also requires clinicians to report the current level of

Discussion: Decreasing the number of therapy visits and increasing the interval of time off between them, patients might be