...Systems Medicaid is a U.S government sponsored program for low-income individuals and families to pay the cost of health care. Candidates are means-tested and the criteria are very strict and vary from state to state and must have less than $1000 in liquid assets. Medicaid covers a wider range than Medicare: hospitalization, x-rays, laboratory services, midwife services, clinic treatment, pediatrics care, family planning, nursing services and in-home nursing facilities for 21+ years, medical and surgical dental care. Medicaid coverage and policies may vary between states and in some states beneficiaries are required to pay the provider a small fee, known as a co-payment, of up to $30 per month for medical services. They also may take payment of deductibles and co-pay for certain services provided. Medicaid is made up of 50% Federal contribution and 50% state. Some states may pay more or less depending on the overall GDP. Medicaid pays almost 60% of all nursing home residents and about 37% of all childbirths in the United States. It accounted for 16.8% of the budget of states and 7% of the federal budget. The Federal Government pays on average 57% of Medicaid expenses. http://www.nls.org/conf/medicare-medicaid.htm Medicare is a U.S government sponsored health care program for people above 65 years of age. Some people under 65 with certain disabilities and all people with end stage renal disease also fall under Medicare. All U.S citizens 65 and older qualify for Medicare and it...
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...choose five events from the 1960s. Identify the basic facts, dates, and purpose of the event in 2 to 3 sentences in the Identify column. Include why the event is significant in the Significance column, and add a reference for your material in the Reference column. * Medicare * Medicaid * The War on Poverty * The Apollo Program * The Department of Housing and Urban Development * The Civil Rights Act of 1964 * Tax Cuts for Economic Growth * Job Corps * National Endowment for the Arts and Humanities * National School Lunch Act of 1946 * Wilderness Act of 1964 * Food Stamp Act of 1964 * The Voting Rights Act of 1965 * The Immigration Act of 1965 * The Rolling Stones * The Beatles * Flower Children * Abbie Hoffman and the Chicago Seven * Kent State killings Event | Identify | Significance | Reference | Medicare | The federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease | The different parts of Medicare help cover specific services Medicare Part A Hospital Insurance, Medicare Part B medical Insurance, Medicare Part C, Medicare Advantage Plans | history.com | Medicaid | Provides health coverage to nearly 60 million children, families, pregnant women, the elderly, and people with disabilities. Medicaid covers US citizens and eligible immigrants. | Medicaid pays for a full...
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...dicussion Lisa Marie Sinotte Walden Discussion Never events are the kind of events that should never happen in healthcare. These “never events” are defined as preventable adverse events by The Centers for Medicare and Medicaid (http://www.cms.gov/). Starting in 2008, The Centers for Medicare and Medicaid Services eliminated or reduced payments for certain “never events” (Thornlow & Merwin, 2009). The Centers for Medicare and Medicaid requires hospitals to report claims for discharges and whether or not selected conditions were present on admission. If a condition is acquired in a hospital, Medicare will not cover the cost of the acquired condition. This “Pay for Performance” initiative highlights the importance of following performance standards to decrease or eliminate “never events”. Preventing patient falls is a universal issue and a “never event”. Falls, and injuries from falls for hospital inpatients are the most frequent adverse events reported (http://www.nursingworld.org). With global emphasis to provide safe quality care, there in now increased scrutiny and inspection for the assessment of falls. The Joint Commission requires accredited hospitals to conduct fall risk assessments so that prevention methods can be implemented into the patient’s plan of care. The National Database of Nursing Quality Indicators allows organizations to compare injury fall rates so that participating hospitals can evaluate the efficacy of their processes, clinical effectiveness...
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...Associate Level Material Appendix A: U.S Health Care Timeline Use the following timeline or create a timeline of your own with eight major events, including the four provided below, from the last 50 years. You may change the dates in the box to match the dates of your events. Include the following in your timeline: Medicare and Medicaid HIPPA of 1996 State Children’s Health Insurance Program (SCHIP) Prospective Payment System (PPS) 1935 | Medicare was signed in 1935; however it did not pass into law until 1965. (ssa.gov, 2012). Medicare was first used for retirement payments only. In later years disability was added to the program.Medicaid was adopted around the same time as Medicare. It was initially meant for the elderly for hospital coverage. In 1965 they added other programs for the Medicaid such as low income families to help receive health coverage. | 1982 | Prospective Payment System (PPS) was created to help control the cost/payments. Medicare would send payments to the hospitals. With the PPS admissions and doctor’s visits were put into categories. (Phillips, 2001). | 1985 | Consolidated Omnibus Budget Reconciliation Act (COBRA), was introduced in order for employers who had insurance coverage to have the option to continue the coverage if they had a job loss. (Paschall, 2010). | 1996 | HIPPA of 1996 was passed in 1996. The reason for HIPPA is to protect people about their health information. Under the HIPPA law no one is permitted to give out information...
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...Care Timeline Use the following timeline or create a timeline of your own with eight major events, including the four provided below, from the last 50 years. You may change the dates in the box to match the dates of your events. Include the following in your timeline: • Medicare and Medicaid • HIPPA of 1996 • State Children’s Health Insurance Program (SCHIP) • Prospective Payment System (PPS) |1960 |Prospective Payment System (PPS)- The mid-1960's brought about the view that access to| | |good quality health care could be provided for the U.S., regardless of ability to | | |pay. The PPS is a means to determine insurance payments for Medicaid plans. It is a | | |Medicare system that pays hospitals a set amount for covered diagnostic or treatment | | |services offered under Medicaid. | |1965 | | | | | | |Medicare and Medicaid- Medicaid is a federal program that provides insurance for low| | ...
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...timeline of your own with eight major events, including the four provided below, from the last 50 years. You may change the dates in the box to match the dates of your events. Include the following in your timeline: • Medicare and Medicaid • HIPPA of 1996 • State Children’s Health Insurance Program (SCHIP) • Prospective Payment System (PPS) |1953 |The department of Health Education and Welfare was the forerunner of the Department of| |1954 |Health and Human Services, and it was established under President Eisenhower. | | |This is when President Eisenhower, as a strong advocate of private Health insurance | | |signs the Internal Revenue Act. | |1964 |The Economic Opportunity Act was signed by President Johnson as part of his | |1965 |administration”s “War on Poverty, a series of legislative efforts to address high | | |levels of unemployment and poverty. | | |Under the auspices of this “Great Society” reforms, President Johnson signs into law | | |the Medicare and Medicaid programs in order to provide the...
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...Associate Level Material Appendix A: U.S Health Care Timeline Use the following timeline or create a timeline of your own with eight major events, including the four provided below, from the last 50 years. You may change the dates in the box to match the dates of your events. Include the following in your timeline: Medicare and Medicaid HIPAA of 1996 State Children’s Health Insurance Program (SCHIP) Prospective Payment System (PPS) 1955 | In 1955 the then Indian Health Services took a new shape as it was taken away from Department of Interior. It was handed over to H.H.S. I learned from ihs.gov that in the past tribal Indians had to submit their land to get health services from US government. The Indian population could get healthy services and this is how their mortality rate decreased. When the services were reassigned to H.H.S. the Indians got more rights to get health services. | 1965 | Medicare and Medicaid came into being on July 30, 1965 as the Social Security Act got revised by the then President L. B. Johnson. The new healthcare programs are federal in type and are mainly for people of 65 and above. People below 65 may be covered if they have some particular disabilities. With these programs people with low or no income get care and | 1971 | The National Cancer Act Law was enacted by President R. Nixon. This law came as governmental war to overcome cancer. If our government paid no attention to this issue, scientists and doctors could not continue their...
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...automobile industry requested $34 billion to aid in their economic struggles (Romney, 2008). Given this chain of events, it should come as no surprise that the health care industry is also facing economic constraints and states, in a frenzy to save money and federal programs, have been forced to slash budgets and cut services in the Medicaid sector. Not all healthcare services will remain at the clinic, but it is important that eliminations do not affect the majority healthcare needs of the Medicaid and Medicare population. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing. Enrollment Expansion and Caps With the economic struggles faced in the banking and automotive industries, millions of Americans found themselves unemployed. With unemployment come a lack of financial resources and an inability to afford some of life’s necessities, including private sector health insurance. Medicaid With slow job growth and lack of reserve finances, many Americans applied for and began receiving Medicaid, a federally and state funded insurance geared to help pay health care expenses for people and families with low income (Dumas, Hall, & Garrett, 2008). They could receive them, due to; many of these recent changes were brought about not through legislation but through waivers of federal requirements. Medicaid waivers allow the federal government, as a long-standing statutory authority, to permit states to alter...
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...Abstract The Affordable Care Act (ACA) brings a myriad of changes to the healthcare system and hospitals must adapt accordingly or face dire financial challenges. Some of the financial challenges will originate from the influx of Medicaid patients due to the Medicaid expansion. Based on these changes, there is an increased tendency for hospitals to engineer ways to reduce costs such as patient selection and staff reduction. However, for a hospital to participate in Medicare, which accounts for more than 50% of hospital budgets, certain laws and regulations must be followed. This paper discusses these laws and regulations and offers suggestions on how to adjust successfully to the upcoming changes. The Affordable Care Act (ACA) and Hospital Compliance In light of the current changes in the healthcare industry, it is imperative for every healthcare organization to adapt accordingly or face dire financial challenges. A major change included in the Affordable Care Act (ACA) is the expansion of Medicaid, which will provide coverage to millions of formerly uninsured US citizens and permanent residents (Rosenbaum, 2011). However, Medicaid is notorious for much lower reimbursement compared to Medicare and private/commercial insurance (M. Schmitt, personal communication, October 7, 2013). In addition, hospitals are now required to prove that the services they bill for actually improve and maintain patients’ health (Leonard, 2013). Hospitals are also required...
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...Medicare and a Never-Event Involving a Patient Transfer Case Week #7 Application MMHA-6205: Health Law and Ethics August 19, 2013 Introduction Who would have imaged the Centers for Medicare & Medicaid Services’ (CMS) initiative would increase the exposure risk to both physician and health care facility alike because of the term “never events”. Never events are inexcusable medical errors that should never occur; the initial list of 28 events defined as “adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability” was compiled by the National Quality Forum in 2001 (Sohn, 2011); pressure ulcers or bedsores was included on the initial list. As for the increased risk exposure for physicians/health care facility, it comes in two forms, the risk of; not being reimbursement by the government and other health care providers; unknowingly file a claim for payment to the government as a result of a never event, as well as; increased medical liability along with the added expense of defensive medicine, which cost the US on average approximately $89 billion per year. CMS (the Centers for Medicare & Medicaid Services is a federal agency within the US Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid and other health related insurance programs (Tavenner, 2011)) “never event” to raise...
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...concealing and detecting; that is; how the fraudulent was committed, how the perpetrator concealed it and how it was detected by the relevant authorities. Focusing on these three areas gives us the opportunity to take an in-depth look into the loopholes that are making it easy for perpetrators of fraud to be able to commit and conceal fraud and how their actions were detected. The paper will focus on only three of the many cases that made the topic of fraud in the healthcare a force to reckon from 2013 to 2015. These cases include a psychiatrist from Chicago, Lloyd Torrez who was found guilty of defrauding insurance companies; Empowerment Non-Emergency Medical Transportation, Inc. an enrolled Medicaid provider being led by its owner, Ms. Shorter, which was defrauding the Indiana Medicaid; and Paula Cluding, owner of Prairie View Hospice in Oklahoma who provided millions of dollars’ worth of fraudulent claims to the federal Medical Care program. INTRODUCTION Fraud is deliberate deception to gain unfair and unlawful gain from an act. It is both civil and criminally wrong, and the people who commit fraud usually do it to gain monetary gain or material benefits, but the ones who commit fraud to gain monetary gains are the most common. The elements of fraud as a crime similarly vary. The requisite elements of perhaps most general form of criminal fraud, theft by false pretense, are the intentional deception of a victim by false representation or pretense with the intent of persuading...
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...Medicare doesn’t relay the same type of long term care that Medicaid does. However , those who have the best Medicaid can offer have poured a lot of time and money into it , to ensure their future financial status and to remain in good health. Insurance only works when the individuals receiving it actually pay the money required to keep it going. With insurance being such a hassle to maintain just for those who have it , imagine those who don’t have it. Its completely demoralizing not being able to provide proper health for yourself and your loved...
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...had ongoing affairs with Cuba. All businesses from the U.S. in Cuba were nationalized without reimbursement. This would lead to the U.S. breaking off relations and imposing a trade embargo due to Castro’s actions. During this time, the U.S.’s involvement in Cuba would increase as they attempted top secret missions to knock down the Cuban Government. Between 1961 and 1963, the U.S. attempted at least 5 times to plot and kill Castro for his actions against the U.S. This event is historically significant because it was the first time where two superpowers came closest to nuclear warfare. These altercations would lead to the U.S discovering the Soviet Union building missile bases in Cuba. This would be known as the Cuban Missile Crises. For almost twelve days the U.S., Cuba, and Russia were locked in a nuclear face off but it ended when President Kennedy made a proposal to remove U.S. missiles in exchange for the de arming of...
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...major events, including the four provided below, from the last 50 years. You may change the dates in the box to match the dates of your events. Include the following in your timeline: • Medicare and Medicaid • HIPAA of 1996 • State Children’s Health Insurance Program (SCHIP) • Prospective Payment System (PPS) |1950 |During this year, most American receives their health coverage through the private | | |insurance market, usually through their jobs. Many people buy their own insurance in | | |individual market. Private health coverage products pool the risk of high health care | | |costs across a large number of people, permitting them (or employers on their behalf) | | |to pay a premium based on the average cost of medical care for the group of people. | | |This risk-spreading function helps make the cost of health care reasonably affordable | | |for most people. | |1960 |Medicare and Medicaid were previously known as Health Care Financing Administration | | |(HCFA). In 1965, the Social Security Act establishing both Medicare and Medicaid. The...
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...Care Timeline Use the following timeline or create a timeline of your own with eight major events, including the four provided below, from the last 50 years. Provide details on these events to help explain why they are important in the health care timeline. You may change the dates in the box to match the dates of your events. Include the following in your timeline (the other four events are up to you!): • Medicare and Medicaid • HIPPA of 1996 • State Children’s Health Insurance Program (SCHIP) • Prospective Payment System (PPS) |1960 |Propective Payment System – 1960 | | |This system was created to set standard rates based off you insurance also to avoid | | |over paying doctors and hospitals Making sure that test and procedures are needed for | | |diagnoisis and treatments. | | | | | | | | |Medicare and Medicaid - July 30, 1965 | | ...
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