...Chapter 9 health and disability insurance |CHAPTER OVERVIEW | Planning a health insurance program needs careful study because the protection should be shaped to the needs of the individual or the family. However, the task is simplified for many families because a foundation for their coverage is already provided by group health insurance at work. We begin the chapter by recognizing the importance of health insurance in financial planning and define health insurance. Then we analyze the benefits and limitations of the various types of health insurance coverage. Private and governmental sources of health insurance and health care are presented next, with a complete coverage of health maintenance organizations (HMOs). Then, we discuss the importance of disability insurance in financial planning and identify its resources. Finally, we explore why the costs of health insurance and health care have been increasing and what is being done to curtail them. |LEARNING OBJECTIVES |CHAPTER SUMMARY | After studying this chapter, students will be able to: |Obj. 1 |Recognize the importance of health |Health insurance is protection that provides payments of benefits for a covered sickness | | |insurance in financial planning. |or injury. Health insurance should be a part of your overall insurance program to | |...
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...Structuring Health Care Erroll Reese Instructor: HSA 500 – Health Services Organization January 23, 2010 Table of Contents Introduction ……………………………………………………………………………………. 3 Identify and describe the three main types of health insurance in the U.S ……………..…….... 3 Describe the three methods for categorizing health insurance in the U.S……………………….. 5 Identify the three types of managed care plans and provide the pros and cons of each for the health care provider, insurer, and patient……………………………………...............................5 Describe the impact of managed care on both the Medicare and Medicaid programs.…………. 8 Conclusion ……………………………………………….……………………………………… 8 References …………………………………………….………………………….……………… 9 Introduction Our stable outlook on the U.S. health insurance sector reflects our belief that industry risk is moderating, business conditions--including growth and retention opportunities and access to capital--have improved, and health insurers' financial fundamentals are now relatively strong. Offsetting these favorable factors are concerns about slowing economic growth, growing governmental fiscal pressures (particularly at the state and local levels), and health care reform issues. We believe these factors will affect each business and individuals differently and will likely keep the number of rating actions moderate for 2012. Identify and describe the three main types of health insurance in the U.S Individual health insurance...
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...The Impact of the Affordable Care Act on North Carolina's Uninsured Population Wendy Patterson Walden University Policy & Advocacy for Population Health NURS 6050-13 Dr. Joan Moon June 30, 2015 The Impact of the Affordable Care Act on North Carolina's Uninsured Population In a speech delivered in the Rose Garden, President Obama stated, “Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate -- we finally declared that in America, healthcare is not a privilege for a few, but a right for all” (US News, 2015). This paper will discuss the impact of the Affordable Care Act (ACA) on the population of North Carolina, the economic impact of providing care to patients from the provider’s point of view, how patients will be affected in relationship to cost, quality, and access to treatment, and what the ethical implications of ACA means for both the provider's and the patients. The Impact of the Affordable Care Act on the Population in North Carolina According to a fact sheet published by the Kaiser Family Foundation, the ACA has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 1.6 million uninsured in North Carolina (KFF, 2015). Although the ACA was signed into law declaring that it was a right for all to have health insurance, individual States had the option of whether to expand coverage for Medicaid recipients. “Being poor, unemployed, or homeless did not...
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...CENTERS FOR MEDICARE & MEDICAID SERVICES Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: • What is a Medicare Supplement Insurance (Medigap) policy • What Medigap policies cover • Your rights to buy a Medigap policy • How to buy a Medigap policy This guide can help if you’re thinking about buying a Medigap policy or already have one. 2013 Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) How to use this guide There are 2 ways to find the information you need: 1. The “Table of Contents” on pages 3–4 can help you find the sections you need. 2. The “List of Topics” on pages 53–56 lists topics in this guide and the page number of where to find them. Who should read this guide? This guide helps people with Medicare understand “Medicare Supplement Insurance” policies (also called Medigap). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover. Table of Contents Section 1: Medicare Basics 3 5 A brief look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What is Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The different parts of Medicare . . . . . . . . . . . . . . . . . ...
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...COMPLETE LATEST HLT-313v Week 2 Topic 2 Discussion 1 A formal risk management plan demonstrates a health care organization’s approach as well as support for risk management and, ultimately, patient safety. Access information from your own employer/organization or using the Internet to find an allied health care organization located in your city or region, and identify the goals and objectives, scope, and functions of an existing risk management plan. How does the plan “measure up” in terms of meeting ethical and legal responsibilities to stakeholders? How might you improve it? Explain. You are required to use and cite a minimum of two references from the GCU Library to support your response. HLT-313v Week 2 Topic 2 Discussion 2 Using the GCU Library, locate and summarize an allied health malpractice or negligence case study. If possible, select your chosen field of study. What went wrong? What workplace safety, risk management, or quality improvement steps were involved? What could have been done differently? If you were in charge of making sure this type of event never occurred again, what steps would you implement into the risk management plan? You are required to use and cite a minimum of two references from the GCU Library to support your response. HLT-313v Week 2 Assignment – Provision and Reimbursement of Health Care Services The areas of provision and reimbursement of health care services have each undergone considerable changes in the past several years, with the following...
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...Alabama Department of Senior Services along with the Department of Health and Human Services are proposing a Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates. This function of change will somewhat affect me because my younger brother recently feel ill to a stroke. In addition, he now is a Medicare recipient because of him being on disability. Furthermore, the interest delves deep because of the fact that both my mother and father is of retirement age. Also, my father is on disability. SUMMARY: We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes would be applicable to discharges occurring on or after October 1, 2011. We also are setting forth the proposed update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The proposed updated rate-of-increase limits would be effective for cost ...
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...financing and payment systems of health care. Many different ideas have been tried and have failed. How would you design a better health care system for the U.S. population? Who would control the health care decisions? Would everyone be required to join? Who would control the costs of care? If the government provided the care, would malpractice lawsuits increase? HLT 418V WEEK 1 DISSCUSSION 2 What impact has health care reform had on the way you receive care for yourself or your family members? HLT 418V WEEK 1 ASSIGNMENT – FOUR COMPONENT OF HEALTH CARE Max Points: 150 Details: There are many reasons why a bill is introduced into legislation, helping a select group of people to make sure that everyone in the country is being protected. It is important as a healthcare provider to understand, how different bills effect the healthcare profession. Select a current health care bill that addresses one or more of the components of healthcare. You will use three to five academic sources to write this paper. Write a 1,250-1,500-word paper about how the bill affects health care services in the community in which you live. Include the following: 1. Summarize the components of the health care bill. 2. Describe the health care components that are addressed in this bill. 3. Who sponsored this bill? Who are the proponents of the bill and who opposes this legislation? What is their position (i.e., why do they disagree?). 4. Does this bill helps or hinders health care services in the community...
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...managing the services and the sharing of beneficiary amounts fluctuate. 3. How are the services paid for? They are paid for by the employer and consumer through high deductable health plans and Health Savings Accounts. 4. How does reimbursement apply? Employees are reimbursed through premiums with a set annual limit. One way is through Health Reimbursement Arrangement (HRA). These plans are popular because it allows the employer to reimburse employees tax free for their personal insurance premium and out of pocket medical expenses up to a certain limit. 5. Are there limitations on care? This approach does not serve everyone equally. Premiums and access to health insurance varies across the nation. Premiums vary with differences in the cost of living, what medical providers are in the area, and the pattern in health care practices. 6. What guides care decisions for patients? 7. What is the quality of services? This plan provides a higher quality of service with better advancements in medicine and healthcare. The healthcare industry is usually paid better and faster so physicians are more likely to provide a better level of care. 8. Are there competitive options? There are large numbers of choices out there to choose from. Consumers and employers may choose from products ranging in health maintenance organizations...
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...Risk Management and Insurance Major Assignment A historical analysis of health insurance in Australia Due Date: 22/5/13 Class: Wednesday 11pm tute Jeremy Fung 3897865 Kwin Trieu 3795138 Tamimuddin Saadzadah 3854247 Zaker Hussaini 3887002 Executive Summary The aim of this report is to analysis and review the Australian Health Care System, We have had a look at the history of the healthcare system in Australia and how it started out in 1901 after the formation of the commonwealth government and the Constitution and the power sharing of the responsibilities and control of the health sector between the federal and state government. The report also analyses the dual private and public health care system, which is the Medicare and the Private Health Insurance (PHI) options for Australian Citizen. The other are that we have reviewed is the legislations related to the health Insurance sector and why is the government so keen in keeping the Private Health Insurance capacity high and what are the benefits of the PHI for the government and the health industry finance. Table of Contents Introduction 1 Australian Health Care System 2 1.1Health Insurance (History) AND Recent Changes in Private Health Insurance 2 1.2 Medicare and the Decline of Private Health Insurance (PHI) Challenge for the Government 3 1.3The role of Private Health Insurance in Australian Healthcare 4 ...
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...Outlook, Strong Internet Research. Trained in CPT-5, ICD-9, and HCPCS coding Strong leadership skills – able to problem solve issues that arise in the workplace in a professional manner Experience in all aspects of insurance: Medicare, Medicaid, and third-party payers knowledgeable in Medical Billing and Coding Guidelines Manage multiple tasks at once, with strict adherence to time constraint Excellent communication skills – Trained and experienced in group facilitation and conflict resolution. Can articulate opinions written and orally. Understanding of Spanish. Highly detailed and customer service oriented and functions well independently or as a team member Experience Tufts Health Plan Medicare Preferred (Watertown, Ma) November 2012 – Current Member Services-Call Center • Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments • Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing. • Verify, document and investigate the presence of health care coverage for Medicare recipients 65 or older\ disabled • Complete periodic reports. • Customer service to include high volume of phone work answering questions and other inquiries regarding Tufts Health Plan • Data entry to include accurate and timely...
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...ASSIGNMENT: 3 ORGANIZATION OF A HEALTH CARE FACILITY HEALTH CARE POLICY LAW AND ETHICS AUGUST 10TH. 2013 Your reputation as a renowned administrator to successfully lead mergers and acquisitions of hospitals precedes you, and you have been hired to create and open a new specialty health care business. This is a clinic with physicians who specialize in the following areas: dermatology, gynecology, heart disease, respiratory disease, surgery, and gastroenterology. It is located in an exclusive neighborhood. 1. Determine whether you would incorporate and state the advantages and disadvantages of doing so. The first order of business is to analyze the demographics of the neighborhood and its residents. Incorporating so many specialties in an exclusive neighborhood can bring about several challenges such as an influx of a variety of individuals from all walks of life. In addition, there could be a traffic nightmare with having so many specialties in a neighborhood such as women with children, old and young adults. The advantages of incorporating multiple specialties in a new clinic would be financially rewarding for the owners. The reason for the financial rewards would be that if one specialty does not do well, then the other would offset any deficits incurred. Another advantage of group practice from the perspective of the provider include shared operation of the practice, joint ownership of facilities and equipment, centralized administrative...
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...Assignment 5: Dealing with Fraud Qui Tam is defined by the phrase “he who sues for the king as well as for himself.” This is a type of legal case in which the whistle-blower or relator files on behalf of the government. The government can then decide to take over the prosecution or not. If the government chooses not to proceed with the case, the relator may continue alone (Showalter, 2012). In order to file a suit, both the plaintiff and the allegations must meet certain guidelines. The same allegations should not have been brought to light previously, unless the qui tam plaintiff is the original source of information that was previously disclosed. The federal law provides a solution for whistle-blowers who are discharged, demoted, harassed, or discriminated against. This type of law suit has become popular and effective in fighting fraud and abuse because of this protection (Showalter, 2012). In healthcare, sometimes the qui tam plaintiffs argue that a claim involving a kickback or an illegal doctor self-referral is a violation of the False Claims Act (FCA). The case may be legitimate otherwise. One case is the United States ex rel. Marcus v. Hess. In this WWII case the contractor’s claims were fraudulent because the contract was secured through collusion. Another case, United States ex. rel. Woodard v. Country View Care Center, Inc. involved defendants who submitted cost reports to Medicare payments to “consultants” that was really kickbacks for referrals. The FCA applied...
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...Reducing Rehospitalizations Elizabeth A Goebel Drexel University Reducing Rehospitalizations Change has become a major buzz word in nursing; everything is changing on a daily basis. If it isn’t the evolution in technology, changes in the reimbursement process, it is introducing new initiatives to reduce rehospitalizations and ultimately improve patient outcomes. Hospitals are under tremendous pressure to reduce their avoidable rehospitalization rates. In October 2012, hospitals started being penalized for having higher readmission rates. Jenks estimates that readmissions within thirty days of discharge cost Medicare more than seventeen billion dollars annually (Jenks, Williams, and Coleman, 2009). There is no doubt that readmissions following a hospitalization are very costly. This issue is critical in nursing today because skyrocketing costs can affect salaries and poor outcomes can be blamed on poor care. The quest for better outcomes proves to be a collaborative effort between hospitals, physicians, case managers, therapists, social workers and caregivers. In May of 2008 St Luke’s Hospital in Cedar Rapids, Iowa implemented a transitions in care program. They understood that the hand off from hospital to home was not working effectively. They focused on being sure that the patient as well as the care givers understood the patients diagnosis, plan of care and plan for follow up care with their doctors. They used the “teach back” method, by having the patients...
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...Government Programs And Accreditation standards Medicare is a federal government insurance program in United States, Created by Congress in 1965, under president Lyndon B. Johnson, and implemented on July 1st, 1966. The purpose of Medicare is to guarantee access to health insurance for US citizens of age 65 and over and to people of any age with disabilities. According to Centers for Medicare & Medicaid Services (CMS), approximately 19 million Americans were enrolled in the Medicare program in 1966. In 2008, approximately 45 million people were enrolled in Parts A or B (or both) of the Medicare program. By February 2012, 12.8 million of the enrollees participated in a Medicare Advantage plan. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States (Torio & Andrews, 2013). The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care A portion of the payroll taxes paid by workers and their employers cover most Medicare expenses. Monthly premiums, usually deducted from Social Security checks also cover a portion of the costs. Medicare’s Impact on Today’s Healthcare Ecosystem Medicare has four parts • Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care. Medical insurance...
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...Jennifer Hunter 07/20/2014 HLTH-1005-5 Assignment Week 1 On an international basis, the development of health care policy is increasingly being influenced by cost considerations. As there are advances in health science and the ability to deliver care continue to expand capabilities of treatments. One major subject of debate has been on the ability of nations and communities to pay for health care with their available resources. One debate has been researched that Americans are paying more for healthcare services than any other nations. It is said that there is a struggle providing health care services and other programs while maintaining economic stability. This could possibly promote frustration for healthcare providers and payers in situations like these. In the efforts to research these concerns of health care policies, it was found that there are significant economic challenges that have direct implications for health care financing and delivery. Concerns about quality could frustrate important changes in health care delivery and financing. Policymakers, payers, managers, and others must confront current and potential quality-of-care problems with the same vigor and sophistication that they are directing to issues of cost. At its best, health care in the United States is superb. Even Americans with insurance, including Medicare and Medicaid, may not always have access to adequate care. At the same time, some Americans may be subjected to inappropriate or unnecessary...
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