Wgu Task 1 Essay

1661 Words Jul 13th, 2013 7 Pages
Healthcare Utilization and Finance
WGU
Organizational Systems &Quality Leadership
KOT1
Lynnell Fulkerson

Healthcare Utilization and Finance
Medicare
A1. Medicare Part A

Medicare Part A covers medically necessary services and supplies including hospitalization

and skilled nursing facility (SNF) care. Mrs. Zwick spent five inpatient days in the hospital and

40 days in a SNF. Medicare Part A will cover 100% of the first 60 days of Mrs. Zwick’s hospital

stay after she pays the $1,184 deductible. Because Mrs. Zwick spent at least three days as an

inpatient in the hospital, and assuming that the skilled nursing facility Mrs. Zwick

is admitted to is Medicare certified, Medicare Part A will pay for 100% of her
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If Mrs. Zwick purchases or rents the walker from a medical equipment supplier

that accepts Medicare assignments she will receive the walker for the Medicare approved cost. If

she does not use a supplier that accepts Medicare assignments she will have to pay the entire

amount up front and she will be responsible for any additional higher cost incurred from a non-

Medicare supplier.

A3. Medicare Part D

Medicare Part D is the portion of Medicare that covers prescription drugs and is separate from

Medicare Parts A and B. There is a monthly premium for this coverage (Medicare 2013 costs at

a glance). Mrs. Zwick should go to a Medicare Network pharmacy to minimize cost. The

amount of coverage she receives will depend on the Medicare Part D plan she has. It would also

be beneficial to remind the daughter to ask if a generic medication is available to lower costs.

B. Reimbursement

Medicare will no longer pay for hospital acquired infections and preventable mistakes and

conditions (Paddock, 2007). Therefore, all costs incurred while in the SNF for care and

treatment of Mrs. Zwick’s UTI will need to be absorbed by the facility. The facility is not

allowed to bill for any portion of the costs related to the hospital acquired infection including

antibiotics.

B1. Ethical Implications

The new graduate nurse complained about the facility not

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