...According to Barton (2010) Long-term Care “emphasized continuous care over a period of at least 90 days for a range of acute and chronic conditions. Regardless of the length of time (i.e., from weeks to years), LTC is an array of services provided in a range of settings to people who have lost some capacity for independence because of an injury, a chronic illness, or a condition” (pg. 349). This is the description of someone who may have been in a debilitating car accident, an elderly person with Alzheimer’s and dementia, a person diagnosed with chronic mental illness, and individuals who are developmentally delayed or “disabled.” People who are placed in these type of long-term care facilities are usually screened using two different measures, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Those individuals have problems or concerns with completing their (ADLs), such as bathing, cooking, cleaning, and grooming. When we think about long-term care, we think that the elder population are the ones who would be more likely to need help with performing ADLs due to illnesses associated with old age. However, this could be further from the truth. There is a great portion of individuals who are in need of long-term care and over 40 percent of them are of working age, with 3 percent being children (Barton, 2010). This percentage of the population who requires LTC, are those who have mental illness or who have developmental disabilities. A lot of...
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...States doesn’t have universal health care, we refer to the Medicare and Medicaid system. Medicare is referred to as “the universal health insurance for elderly people” (Barr, 2011, pg.132). Medicare is a federal program that helps all people 65 years or older pay for healthcare. Those who qualify for Social Security benefits are automatically eligible for Medicare (Barr, 2011). When Medicare was passed in 1965, only 56 percent of elderly people have hospital insurance. It was a strong national consensus that none of the elderly in United States should face financial ruins because serious illnesses were seen as a threat to financial security of seniors (Barr, 2011). Due to that reason, Medicare was created to ensure financial stability. Not only does Medicare cover people 65 years and older, but it also covers individuals with certain disabilities, and individuals with End-Stage Renal Disease that requires dialysis or transplant (Medicare.gov). Unlike Medicare, Medicaid was not created as a program for all people who fall below that poverty line. It only covers certain subgroups of poor people (Barr, 2011). Medicaid provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance, health care to children, pregnant women, parents, senior, and individuals with disabilities (Medicaid.gov). Medicare is made up of four different parts: part A, B, C, and D. Medicare part A is a service plan for hospital care. All people eligible...
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...Medicare and Medicaid reimbursement rate: The payment rates are currently set below the cost of providing care, resulting in underpayment. In 2010, for Medicare, hospitals were paid only 92 cents for every dollar that was spent on Medicare patients. For Medicaid, hospitals received payment of only 93 cents for every dollar spent by hospitals caring for Medicaid patients. Eligibility requirement for Medicaid in CT * Low income children and families * Low income seniors * Disabled * Children with special health care needs What does 100 percent or 150 percent of poverty mean? The federal poverty level represents the level at which poverty or subsistence begins. Each year, the federal government determines this number based on inflation and other relevant factors. The federal poverty level guidelines are used as an eligibility criterion for federal, states and local government programs. 100 percent of poverty mean- an individual or household’s annual income is equal 100 percent of the federal poverty level. 150 percent poverty mean- an individual or a household earns 50 percent more than the federal poverty level. In 2012 for instance, the federal poverty level for an individual was $11,170, so an individual at 150 percent of federal poverty level earned $16,755. How are Medicare and Medicaid funded? Medicare is partially funded from payroll taxes, through the provisions of the Federal Insurance Contributions Act. The Medicare tax rate is currently 2.9...
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...Medicare versus Medicaid A Brief Comparison Medicare versus Medicaid: A Brief Comparison The Federal government has two distinct programs to provide health insurance coverage to citizens, Medicare and Medicaid. The two programs, while helpful to those individuals who qualify, are not available to everyone. In this paper, I will briefly define and discuss the two programs, their similarities, and their differences. The first program I will discuss is the Medicare program. President Johnson signed Title XVIII of the Social Security Act, also known as Medicare, into law on July 30, 1965 with coverage beginning in 1966. When Medicare first began, it consisted of two basic parts, known as Part A, and Part B. Medicare Part A provides hospitalization coverage automatically to all citizens age 65 and older. It helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not have to pay a premium for this service because they or their spouse has already paid for coverage through payroll taxes. (Medicare Gen Info) For those who do not qualify for premium free service, an annual deductible of forty dollars per year was established. . Since then, like everything else, Medicare Part A premiums have increased. “The $1,024 deductible for 2008, paid by the...
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...Medicare and Medicaid Reimbursement for Primary Care Introduction The Social Security Act of 1965 created Medicare and Medicaid, which provides health care coverage for the elderly, poor, and disabled. Medicare has become the largest single payer health entity spending $57.9 billion in 1980, $271 billion in 2003, and $513 billion in 2010 (Social Security Administration, 2012). Whereas, Medicaid being state funded, its governance is state-specific for spending. There have been very few changes to The United States health care payment system since Medicare’s and Medicaid’s inception, until March 23, 2010, when President Barac Obama signed into law the Patient Protection and Affordable Care Act (ACA). The three main goals of the ACA are to: increase the access to health care for all Americans, increase their quality of care, and make this care affordable. Unfortunately, despite the ACA’s good intent, its scope was far reaching, glossed over current problems within health care, and created more issues. It is filled with contradictory verbiage that required multiple teams of lawyers to decipher (with many different interpretations), and changed health care reimbursement with unknown consequences. Description of Policy and the Legislation The ACA attempts to solve the reimbursement problems in several ways. The act established the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services, which is responsible for overseeing voluntary...
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...Medicaid/Medicare Services Stella Williams Harrison College Medicaid/Medicare Services Develop a plan for the center by using clinical quality measures, or CQMs, which are tools to help track and measure the quality of health care serviced that are provided by eligible professionals, eligible hospitals that are within the health care system. These would be measures to use data that is associated with providers that are able to provide high quality care or relate to long term goals for health care. The measures would be the many aspects of patient care including: * Health outcomes * Patient safety * Clinical processes * Efficient use of health care resources * Population and public health * Adherence to clinical guidelines * Patient engagements * Care coordination By reporting and measuring CQMs in a three month or 90 day reporting period will help to ensure that the health care system is safe, efficient, effective, patient centered, timely care and equitable. According to the EHR Incentive Programs the need to report the measures will demonstrate meaningful use and receive an incentive payment so the CQMs may be reported electronically or via attestation. The CQMs are identified into core sets and they are highly recommended so the focus can be on conditions that contribute to the morbidity and mortality of most Medicare and Medicaid beneficiaries with some factors that would be recommended, the Center would have to have certain conditions...
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...Historical Legislation from 1965: Medicare and Medicaid Liliana Martinez Dr. Smith Grand Canyon University: HCA-460 3/7/13 Historical Legislation from 1965: Medicare and Medicaid The Medicare and Medicaid programs were signed into law on July 30, 1965 by President Lyndon Johnson ("Centers for Medicare," 2012). Before this decision was even taken into consideration, many other healthcare reforms had previously been introduced by earlier presidents, but failed to pass the Senate. Healthcare issues have always been on board for the United States, but during this time the elderly and the poor were desperately screaming for help. The government had no choice but to come up with a solution to their healthcare needs; these two populations were left with no options but to trust the government and their ideas towards solutions. These solutions are called Medicare and Medicaid, which at that time served more than 19 million individuals ("Key milestones in," 2006). After the implementation of these government health programs, almost yearly new premiums were added and adjusted to them. Medicare as previously stated is a government insured program provided for the elderly usually starting at the age of 65 and older along with certain younger people with disabilities. There are four different parts to the Medicare program. Part A deals with hospital insurance, this part helps cover inpatient care in hospitals, hospice, and skilled nursing facilities. The majority of the people...
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...Are Doctors accepting Medicaid Patients as Obama has Signed the Affordable Care Act Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Arunabh Sinha Arunabh Sinha Abstract On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be turning sixty-five thus qualifying for Medicare. Although fewer doctors are accepting government insured patients! This paper will research the number of doctors accepting governmentally insured patients and also if there is a shortage in the number of providers as the PPACA goes into effect. With data provided from the American Medical Association (AMA), Center for Disease Control (CDC), and other academic journals an evaluation is going to be made of if there is enough doctors to meet the demand of newly insured patients in the US. Issues of access and quality of care will also be addressed in this paper. Are Doctors accepting Government Insured Patients as Obama has Signed the Affordable Care Act On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be...
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...T ackling Fraud, Waste, and Abuse in the M edicare and Medicaid Programs: R esponse to the May 2 Open Letter to the Healthcare Community Dan Olson, CFE June 2012 Tackling Fraud, Waste, and Abuse in the Medicare and Medicaid Programs White Paper C ontents I. Introduction ............................................................................................................ 1 II. Recommendations................................................................................................... 3 Recommendation 1 – Expand the Medicare Fraud Strike Force Model....................................... 3 Potential Savings .......................................................................................................................... 4 Recommendation 2 – Expand Integrated Data Repository .......................................................... 4 Potential Savings .......................................................................................................................... 5 Recommendation 3 – Expand “Do Not Pay List” .......................................................................... 5 Potential Savings .......................................................................................................................... 6 Recommendation 4 – Publicize Drug Expiration Dates ................................................................ 6 Potential Savings ....................................................................
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...Team 1 Discussion Outline i) Reimbursement Rates for Medicare and Medicaid to hospitals 1) Rates are currently below cost of providing care (underpayment) 2) Underpayments totaled $27.9 billion in 2010 a) Medicare i) 92 cents reimbursed for every dollar spent (2010) ii) 53% of hospitals received payments less than cost b) Medicaid i) 93 cents reimbursed for every dollar spent (2010) ii) 59% of hospitals received payments less than cost ii) Eligibility requirements for Medicaid in your state 1) Indiana a) Medicaid program provides medical care to nearly 1,000,000 Hoosiers b) Department of Family Resources determines eligibility and need i) Qualified parents ii) Children iii) Pregnant women with low income iv) Older adults and people with disabilities with low income c) Affordable Care Act of 2010 i) Medicaid minimum eligibility level that covers most Americans with household income up to 133 percent of the federal poverty level ii) New eligibility requirement effective January 1, 2014 2) Connecticut a) 712,350 currently enrolled in Medicaid program b) Eligible requirements i) Low income children and families ii) Low income seniors iii) Disabled iv)...
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...Managed Service Provider Contractor Welcome and Orientation Guide for Contract Assignments at Bank of America Revised: 5/18/2010 11:42 AM Code of Conduct and Workplace Etiquette Food at workstations The type and amount of food at workstations can cause distraction to teammates and interfere with servicing customers. Some guidelines follow: ♣ Food must not distract you, teammates, or the customer, and should not be detectable by any customer. ♣ Food must not be messy, attract insects, mice, or lead to unsanitary conditions. ♣ All beverages must be in containers with a sealed lid. ♣ Meals should be eaten in the break rooms during breaks or scheduled lunch time. Breaks and Lunches All breaks and lunches are to be taken away from your desk or work area. Smoking Area There are smoking booths located at some Bank of America buildings, for others, during breaks or lunches make sure you are 25ft away fr entrance. Be courteous to others and pick up after yourself (this includes: cigarette butts, used matches, etc.). For Call-Center environments, you may not sign off the phones to smoke if you are not scheduled for a break. Cell phones, pagers, PDAs, and digital cameras: All cell phones, pagers, palm pilots, iPods and PDAs must be turned...
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...facilities rely on JCAHO accreditation procedures to indicate to the public that their particular institution meets quality standards”(JCAHO). JCAHO and its policies have taken on a real importance in the medical field, despite the lack of official government sanction. The Joint Commission is an independent, private sector in the United States that administers accreditation programs for hospitals and other healthcare-related organizations. The Commission develops performance standards that address crucial elements of operation, such as patient care, medication safety, and infection control and consumer rights. Most state governments require that healthcare organizations be accredited by the Commission as a condition for licensing and Medicaid reimbursement. JCAHO evaluates and accredits approximately 18,000 health care organizations, including hospitals; ambulatory surgery centers (ASCs), health care networks, and clinical laboratories. The Joint Commission was founded in 1951 as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Joint Commission Resources (JCR), a global affiliate group, oversees the Joint Commission International (JCI). In this essay I will continue to use the monopolistically...
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...people who enter a nursing home will stay there five years or more. (www.medicare.gov/LongTermCare/Static/Home.asp) Long-term care financing is a growing concern over recent years. The number of elderly Americans in proportion to the total population is rapidly increasing. Individuals need to plan well in advance in order to cover the burden that it places on individuals, families, and society. The average annual cost of nursing-home care in the US was $74,000 in 2005 and is projected to rise to $175,000 by 2020. This amount would decimate the assets of all but the wealthiest. (Weisser, 112) The federal and state governments along with the private sector are struggling to define the roles of delivering care to the elderly. Medicaid, Medicare, and Private long-Term Care Insurance are current ways to finance our elderly care. While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the...
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...Regulatory Agency Regulatory agencies ensure health care practitioners and facilities promote safety, legal compliance, and quality patient services. If health care were not regulated of if accreditation were not required patients would not have a sense of comfort and safety. The regulatory agency the Joint Commission on the Accreditation of Healthcare Organizations commonly known as JCAHO, which “conducts periodic on-site surveys to verify that an accredited organization substantially complies with Joint Commission standards and continuously makes efforts to improve the care and services it provides” (The Joint Commission, 2010, p. 3). The JCAHO ensures that health care providers and facilities are maintaining the required standards of care in place by the regulatory agency. JCAHO is constantly improving the quality and safety of care provided in any health care facility. History of the Joint Commission of Health Care Organizations In 1910, Ernest A. Codman, M.D., found that many health care practitioners were practicing medicine that was outside their scope of training. It was then that he “proposed the end result system of hospital standardization. Codman thought that if hospitals were to track every patient and the patient were treated long enough it could be determined whether the treatment was effective and use the results to improve care” (2010, A Circular Century, p. 26). In 1913, the American College of Surgeons (ACS) was established and by 1917, the...
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...Annual reports are given as comprehensive as possible, reporting a company's prior years activity. Shareholders and other interested parties are given information concerning the company’s financial performance. These reports must be filed with the company’s registry and may be required to be publicized, it depends on the area. More regular reports are required of those companies listed on the stock exchange. Most reports contain: Chairperson's report, CEO's report, Auditor's report on corporate governance, Mission statement, corporate governance statement of compliance, Statement of directors' responsibilities, Invitation to the company's AGM and financial statement information. [pic] Lincare Holdings Inc. was founded in 1972 and is headquartered in Clearwater, Florida. Providers of oxygen and other respiratory therapy services to home health care market in the Lincare Holdings Inc. also supplies home medical equipment ( hospital beds, wheelchairs and other supplies) that present helpful to consumers. State-of-the-art oxygen system producers from 1965. Known for making 24-hour, seven-days-a-week reliability, professional service representatives, and staff, Lincare provides: Oxygen Therapy, Respiratory Services, Infusion Therapy, CPAP, Ventilators, NVS, Enteral Therapy, Pediatric Respiratory Services, Patient Education & Rehabilitation. Individualized services to the prescribed need of each patient. Sanitarily providing respiratory equipment with monitors to...
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