Questions On Health Insurance Coverage

Medicare, the federal governments health insurance program, finances acute medical care for nearly all elderly Americans over the age of sixty-five. However, very few long-term care services are covered. Medicare finances long-term care only partially through it’s limited skilled nursing facility (SNF) and home health benefits. “Despite recent growth in spending on these benefits, much of the SNF and home-care paid for by Medicare remains short-term rehabilitative care, often related to a hospital stay or outpatient procedure. Medicare covers SNF care for up to 100 days following a hospital stay of at least three days. For homebound persons needing part-time skilled nursing care or therapy services, Medicare pays for home health care, including personal care services provided by home health aides.” (Feder, Komisar, and Niefeld) All that is not covered, the elderly are expected to cover with savings, private insurance policies, and financial support

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.

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

Since the original plan for SNF stay was 21 days, which is the total number of the days paid by Medicare Part A 100%, there was going to be no out of pocket pay from the patient’s side if there would have not been a UTI acquired. Objective findings show that the UTI was due to poorly performed evidence-based protocol process in the urinary catheter maintenance and fitting. This cost the patient to start paying money ($144.50/day x 14 days as explained before) out of her pocket for cause that was not inevitable. Not only did the patient have to suffer being weak, having and infection and missing on her rehabilitation program, but she had to also pay for each extra day that she had to stay there for a fault that was not hers. It is clearly not only a failure of the SNF’s operational system, quality of care and healthcare professionals’ performance, but also of the governmental support which directly penalizes the patient for

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

Contrary to this, anecdotal reports stated that other clinicians sometimes spend more times in checking and treating patients with severe illnesses or who are in critical conditions, which made the physicians care for a greater number of patients with lower acuity. Whenever a physician and clinician bill for the same service, it is very difficult to tell if the physician saw a more complex patient. Due to these uncertainties in comparing their services, the Commission is reluctant in altering the payment differential. From that discussion, every provider must be familiar with some fundamentals about Medicare. First and foremost, there is Medicare Part A, which actually covers skilled nursing home, hospital, and home health charges; and then there is Medicare Part B, which then envelops most outpatient services, the care that patients in particular obtain from a doctor’s office (Fishman, 2002).

In many circumstances, people may move out of long-term care. Those recovering illness or injury may regain independence after they are well. Some may not every be able to live a life without long-term care again. It is noted that 40 percent of people over 65 will need two or more years of long-term care with half of those needing care for more than five years (Grote, 2011). Unfortunately, with today’s aging population, the numbers in the long-term care are most likely to keep increasing instead of transitioning people out. Of the 12 million people who need LTC, 6.6 million are age 65 or older and are likely to be Medicare beneficiaries and entitled to the LTC coverage that Medicare provides (Barton, 2006). That said, not everyone who

The first piece of legislation (one legislation I discussion 2 pieces of that) discuss is section 101 part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a bipartisan legislation signed into law on April 16, 2015. This law was created to replace the current law in that time Medicare reimbursement schedule with, the revolutionary idea of new program supposed directed focus on the quality, value and accountability of the national health care program. The CMS describe MACRA as a modern system new payment framework, supposed rewarded the national health care providers to obtain the better care instead of more service, looking for value over volume. The information’s observed in the interview provides consistent points

This paper deals with the legislative, regulatory components of Medicare Readmission Reduction Program along with recommendation to reduce their readmission rates for a health care facility like Valley hospital in Spokane which has been penalized a higher percentage of 2% as compared to other hospitals in the state of Washington under the third round of penalties.

The issue of healthcare coverage under the federal health reform has been politically debated by many Americans, including the current Democratic presidential candidates Hillary Clinton and Bernie Sanders. The healthcare reform enacted in 2010 under President Obama’s regime intended to support the ongoing healthcare system as a building block to enhance more access to health insurance coverage for millions of uninsured Americans; yet the government’s tireless effort to ensure all individuals are covered remains a major issue across the country.

For instance, patients are treated in rehabilitation hospitals are usually recovering from a major injury like stroke or a broken hip. Outpatient patients are expected to be able to do the basics of everyday life but need to be helped with a specialized task.

In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).

One financial problem the healthcare industry is facing right now is healthcare collections. Healthcare collections have always been a financial problem to healthcare industries because of nonpayment from the uninsured and individuals who are uneducated about their health plans. Nonpayment to healthcare industries means a loss of revenue. A loss of revenue means that health care industries may run the risk of exhausting their financial resources and become unstable. This financial problem is very typical in the healthcare industry.

Ms. Coats is appreciative of her Medicare but states, “it does have its drawbacks.” While having knee replacement she developed blood clots in her lungs and Congestive Heart failure in which she gained seven pounds in two days. After the doctors had started to get this under control, they wanted to send her to the Hospital

Medicare medical coverage arrangements will help senior natives to cover the vast majority of their medicinal services costs. Individuals who are over the age of 65 or those with some interminable issue are qualified for Medicare arranges. These are grouped into Part A, Part B, Part C and Part D. Section A - or doctor's facility scope pays for inpatient clinic administrations, home human services, hospice care and nursing care after healing facility remain. Medicare Part B covers restorative costs, outpatient doctor's facility treatment and clinical research center administrations. Section An and Part B are the first Medicare arranges. A great deal of fundamental medicinal services expenses are secured by Part An and Part B. Be that as it may, these arrangements are won't cover co-installments and deductibles. Medicare Part D covers brand name and non specific physician