...Health Policy Unit 4 IP Cassandra Nunnelly AIU Online October 25, 2013 Abstract The Medicare Prescription Drug, Improvement, and Modernization Act 2003, was signed into existence by President Bush on December 8, 2003. To approve the H.R. 1, the Medicare Prescription drug and modernization conference agreement, on November 22, 2003, the House of Representatives voted 220 to 215 and on November 25, the Senate voted 54 to 44 in order to approve the conference agreement. This Act over the years is intended to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare 2003. Health Policy The Medicare Prescription Drug, Improvement, and Modernization Act 2003, was signed into law by President Bush on December 8, 2003. To approve the H.R. 1, the Medicare Prescription drug and modernization conference agreement, on November 22, 2003, the House of Representatives voted 220 to 215 and on November 25, the Senate voted 54 to 44 in order to approve the conference agreement. This Act is created to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare 2003(Jennifer O’Sullivan, Hinda Chaikind, Sibyl Tilson, Jennifer Boulanger, and Paulette...
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...Pay your bills with Medicare supplement plans Many a times when people tend to get sick and visit the hospital, the series of tests which are prescribed by the doctors tend to leave the patients in a worse shape than before, however, while knowing that they are fine, there is one exception which is about to change that and that is the medical bills which are a huge bomb on the patients visiting without insurance. The reason why they cannot afford insurance is quite simple, companies tend to charge a lot of ridiculous sums that they cannot pay, however, to reach out to these customers and provide them with an option to pay, the brand new Medicare supplement plans have now been introduced that allow people to visit the hospitals more confidently...
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...Hospital Reimbursement – Differences Between Medicare and BWC The two tables below provide a summary of areas where the Ohio Bureau of Workers’ Compensation (BWC) differs from Medicare for reimbursement of hospital inpatient and outpatient services. Use this document as supplemental material to support Ohio Administrative Code Rule 4123-6-37 Payment .1, of Hospital Inpatient Services, and Rule 4123-6-37 Payment of Hospital Outpatient Services, for the .2, effective dates specified at the beginning of each table. 4123-6-37.1 Payment of Hospital Inpatient Services Effective for Discharge Dates from Feb. 1, 2011, to Jan. 31, 2012 Area Payment adjustment factors Medicare 100 percent of the Medicare rate (Includes both the Medicare portion and the beneficiary portion) BWC • 120 percent of inpatient • • • prospective payment system (IPPS) rate for inliers (non-outlier bills). 180 percent of IPPS rate for outliers Additional 0.25 percent adjustment to restore Medicare’s market basket adjustment Additional 2.9 percent adjustment to restore Medicare’s documentation and coding adjustment Hospital acquired conditions (HACs) provision Reduces IPPS payments when hospitals meet the HAC criteria Excludes the HAC provision Direct graduate medical education per diem (DGME) Does not provide DGME per diem payments under IPPS Provides a per diem add-on payment for DGME for eligible providers Does not reduce IPPS payments Does not apply DGME per diem addon payments to outlier bills...
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...Accountable Care Organisation (ACO) under the Medicare shared saving Program. The Patient Protection and Affordable Act authorises CMS to create the MSSP that help doctors, hospitals and other health care provider in coordinating care for Medicare patients through ACO. An ACO is a network of group of provider and suppliers who work together to provide high quality care for the Medicare Fee-for service patients they serve. The ACO model was developed by Fisher, that private hospitals and organisation can be grouped into virtual organisation that is accountable for cost and quality of the range of care services delivered to Medicare patients. ACO work to provide high quality care to Medicare enrolees while simultaneously reducing health care costs. ACO is accountable to beneficiaries of Medicare for cost, quality and care. Till now eight private health insurance plans have entre with provider into ACO agreements that shares a payment risk model. Keeping the cost below a benchmark will make providers eligible for bonuses and incentives (Berenson & Burton, 2012). Objectives of ACO The main goal of ACO is to provide effective, accessible and coordinated care to patients it serves. ACO assures that care is delivers in a cultural component manner. The organisation aims to deliver seamless supreme quality care to beneficiaries of Medicare. In ACO the beneficiaries and providers work as true partners in ACO’s care decision making process. The satisfaction of patients by delivering...
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...Health care policy goals toward the society are delivery and financing of health care services. Health policy generally clarifies the movements occupied by governments---local, state, and national---to improve the society's health. It is a policy that stays focus more on discussing the health needs on majority of the population. The United States of America is the foremost spender on health care than any other country on earth (policy almanac, 2010). For a number of years, health care expenditures grew at a far more rapid rate than the Gross Domestic Product (GDP), using majority of the country‘s capitals. The cost of health care and the determination to control the intensification in spending is a major conflict. The upsurge in cost and spending of health care affects many policies as well as the consumer, physicians, government, children, and senior citizens. The focal focus is based on the first three phases of how the procedure works with Medicare/SCHIP. Policies are dynamic. There are three interconnected phases of health care policy making: the formulation stage, legislative stage, and implementation stage. These three important organized stages occur in the process in order to convert a topic such as Medicaid, into a policy. To begin, the formulation stage is a planning cycle by stating a theory. It is the main and frequently most challenging stage in obtaining proper decision methods. The obligation of this stage is to set priorities, set objectives and goals, define...
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... DR. TAMI RESIGNER Abstract In November of 2003, President George Bush signed a controversial law that had been passed into by the United States Congress. The new legislation made changes to Medicare that was necessary in order to make Medicare better for elderly and the disabled. Some felt like the changes was for the better, and some felt like the changes made Medicare worst. The paper that I will be presenting today is about the new Medicare plan that the U.S. Congress passed in November of 2003. This paper will be answering a couple of important question, that will farther help one to understand what Medicare was like from when it was first established in 1965, until the new changes came into effect November 2003. And the question will be answered in the following order. 1. Why was it deemed necessary to change Medicare? The reason why changes were deemed necessary in Medicare was because seniors began to notice that the medication that they needed for their health was becoming too costly for them to buy from the pharmacy. And this made the legislation wanting to change Medicare in order to make health care plans for the elderly more affordable, and the second reason was to cut the overall spending of Medicare, because it is said that the way it look if Medicare don’t reduce its spending, it will come to an end in the year of 2026(www.medicalnewtoday.com). 2. What was the main provision of the New Legislation? The new legislation main provision is to make...
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...medicare.gov, Medicare insurance coverage is governed by federal and state laws, and the decision of whether a service is covered, or not, is made by Medicare. Moreover, insurance coverage/decisions are handled by local companies that process Medicare claims. These companies will make the decisions of whether procedures, and/or interventions recommended, are medically necessary, and whether that particular service is covered in their area (Medicare.gov). Scenario# 1 A1. Medicare Part A Explaining insurance coverage to Mrs. Zwick, and her daughter, must be done in a simple and informative manner, keeping in mind that insurance coverage is a complex process that often varies. However, below are some pointers to be addressed during the Mrs. Zwick’s discussion. Medicare Part A, A.K.A. hospital insurance, insures hospital services days (inpatient care, general nursing care, meals, medications, semi-private/private room if medically necessary, and supplies), and up to 100 days of coverage in a Skilled Nursing Facility (SNF). To qualify for Medicare Part A coverage, the physician orders must include the amount of midnights (count) needed to treat the illness and/or injury. Patients must stay in the hospital for over 72 hours (admitted for inpatient medical care). Hospital stay less than 72 hour, will be considered as outpatient care, and a disqualifier for coverage. At discharge, the primary care physician (PCP) must write an order for SNF services. The Medicare Part A coverage...
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...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 1.4 Economic impacts on Health Insurance 7 Risks of Health Insurance 8 2.1 Purpose of health insurance 8 2.2 Risk Management and private health insurance 8 2.3 Health system costs and benefits 9 Regulation of Health insurance 10 3.1 How is private health insurance regulated? 10 3.2...
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...Final Project Financial Policy Part A Tracie Blakeslee HCR/230 November 3, 2013 Santresa Sanders NEWFIELD FAMILY MEDICAL PRACTICE FINANCIAL POLICY Here at Newfield Family Medical Practice our main objective is to provide the highest quality of healthcare and to try and keep the cost of medical care down. For us here at Newfield Family Medical Practice to achieve these you as our patient need to understand our financial policy. Please read this carefully and if you have any questions, please speak to any member of our staff (“American Academy of Pediatrics”, 2013). 1. On arrival please come to the receptionist desk and check in with the front end staff, present them with your current insurance card, you will be asked for it at every visit, inform the front end staff of any changes that have been made such as name change, address, telephone, emergency contact person, or insurance provider. You will be asked to sign in once all information has been verified. IF THE INSURANCE CARD YOU PROVIDE IS NOT CORRECT, YOU WILL BE RESPONISBLE FOR PAYMENT FOR MEDICAL SERVICES FOR THE VISIT, AND WILL BE RESPONSIBLE TO FILE A CLAIM WITH THE CORRECT INSUANCE PROVIDER. 2. Newfield Family Medical Practice must appear on your insurance card if we are your primary care provider, if your insurance company has not been notified that we are your provider on the date of your appointment, you may be financially responsible for the visit (“American Academy of Pediatrics”, 2013). 3....
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...Legislative Health Care Policy and Processes Syeeda Daniels Baker College Abstract The United States legislative health policy process is very complex, it has a chain of command it has to follow before policies are set in place, this paper will explain what the legislative health policy is in the united states, and how its process is related to the principal features of united states health policy. I will discuss the critical policy issues related to the access to care, cost of care, and quality of care. Legislative Health Care Policy and Processes The legislative process is not a simple process, it begins when a member in congress determines that a problem exist, then a proposed solution to the problem “a bill” is presented to the committee that handles the issues presented in the bill (Singh, 2015, p. 524). Once the bill is amended it is forward to the house of representatives and the senate to vote on whether or not to pass the bill (Singh, 2015, p. 524). If they don’t agree the bill is not considered. If the bill is pass by the house of representatives and the senate it goes to the President of the United States, who either signs the bill or vetoes it (Singh, 2015, p. 524). Congress then has the power to override the veto (Singh, 2015, p. 524). Health policy as defined by the CDC are laws, regulations, procedures, administrative actions, incentives, or voluntary practice of governments and other institutions that influence the health of society (CDC, 2015)...
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...physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; • Medicare alludes to a federal health insurance program that covers individuals with 65 years and above. The policy also covers other classes of people such as individuals with disabilities, individuals with End-Stage Renal Disease. The health insurance is sponsored by the U.S. government under a special...
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...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 policy: This kind of health insurance policy covers you (the policyholder), your spouse and your dependents. Generally, an individual health insurance policy is more costly than a group health insurance policy, since the policyholder is responsible for all premium payments. Here are just a few benefits to having an individual health insurance policy:...
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...billing for services that were not provided. "Abuse" occurs when a provider or supplier bends rules or doesn't follow good medical practices, resulting in unnecessary costs or improper payments. Examples include the over-use of services or the providing of unnecessary tests. (Another area, "waste," refers to health care that is not effective, and will be the subject of a separate Health Policy Brief.)Endowed with new powers under the Affordable Care Act and the Small Business Jobs Act of 2010, the Centers for Medicare and Medicaid Services (CMS) has been adopting new tools to curb fraud and abuse in the Medicare and Medicaid programs. The new approach amounts to a paradigm shift from the earlier model, in which CMS paid providers first, then sought to chase down fraud and abuse after the fact--a process known as "pay and chase."This policy brief focuses on eliminating fraud and abuse in Medicare and Medicaid and explores the challenges involved in putting the new tools into place. | What's the background? | The true annual cost of fraud and abuse in health care is not known. In fiscal year 2011 Medicare spent $565 billion on behalf of its 48.7 million beneficiaries, while federal and state Medicaid agencies served 70 million people at a combined cost of $428 billion. CMS estimated that in fiscal year 2010 these two programs made more than $65 billion in "improper federal payments," defined as payments that should not...
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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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...to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; * Medicare alludes to a federal health insurance program that covers individuals with 65 years and above. The policy also covers other classes of people such as individuals with disabilities, individuals with End-Stage...
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