...The Recovery Audit Contractor or RAC program was created through the Medicare Modernization Act (MMA) of 2003 in order to identify, review, audit and recover improper Medicare payments that were paid to healthcare providers under fee–for-services Medicare plans. There are four RAC’s and each one is responsible for a designated region and each one has its own plan for targeting issues. The RAC program helps providers avoid submitting claims that do not comply with Medicare rules. According to the United States Department of Health and Human Services, they were required by law to make the RAC program permanent for all states by 2010. When the program was first introduced as a demonstration in 2005 it focused on the states of California, Florida and New York. During this time of demonstration the RAC program focused on improper payments made under the part A and B plans of Medicare and had recovered nearly six hundred and ninety three million dollars. Currently in the state of California, The California Medical Association (CMA) is pushing congressional members to co-sponsor The Fair Medical Audits Act of 2015. This legislation will address many issues and concerns that physicians have regarding the lack of clear, expensive, time consuming and unfair process that plagues the Medicare Recovery...
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...2010 October 31, 2010 1) Identify and describe at least three main types of health insurance in the U.S. The main types of health insurance are voluntary health insurance, social health insurance, and welfare medicine. In voluntary insurance or private health insurance in the United States can be subdivided in to three distinct categories: (1) Blue Cross and Blue Shield, (2) private or commercial insurance companies, and (3) health maintenance organizations. Nowadays, it is common for Blues and commercials to own and operate HMOs and other managed care plans. Social Health Insurance has two major mandatory social health insurance programs: (1) Workers’ Compensation for the costs and pain of suffering job-related accidents, and (2) Medicare for the elderly, disabled, and other special groups. Several states sponsor social insurance programs in the areas of temporary disability (California) or health insurance (Hawaii and Vermont). Workers’ Compensation provides two basic benefits: (1) cash replacement of a portion of wages lost due to disability and (2) payment for all or part of the medical care necessary. Welfare Medicine is a public assistance that is sponsored by a plethora of federal, state, and local government programs, but the most far-reaching program is Medicaid (Title XIX of the Social Security Act). The distinction between welfare medicine and social health insurance, both of which are public programs, is an important one and rests on the philosophical difference...
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...Abstract Whether you are an economists or the average consumer, Health Care costs and spending seems to always be a hot topic. From my initial research I found that Health Care costs are steadily rising both in the private and public sectors. From what I have read I believe some sort of Health Care reform is required. There are vast numbers of people suffering and even dying because the cost of Health Care is too expensive. Unfortunately people skip doctor appointments and ignore ailments, just because they cannot afford it and it some cases people are paying the ultimate price. I’d like to look a little deeper into the Pros and Cons of Private and Public Healthcare and delve a little into some of the Health Care reform Bills that are in play or will be implemented in the near future. Specifically I want to look at Obamacare, as I hear it in the news, but do not know what impacts it has to the economy, good or bad. List of Figures Figure 1 6 Figure 2 6 Figure 3 7 Figure 4 7 Health Care Reform In recent years, a fair amount of attention has been geared towards Health Care. There has been a number of Economists that have voiced concern that rising health care spending could hurt the economy and lower employment. A December 2004 survey of CEOs found that employee health care costs are the greatest cost concern of America’s business leaders. (via aspe.hhs.gov). Due to the ever rising cost of healthcare, I found that approximately 53 Million...
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...isn't Constitutional and what that means for the people of the United States. The Patient Protection and the Affordable Care Act, also known as Obamacare is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965 (Wikipedia 2012). The main focus of Obamacare is to leave no person without health coverage. The majority of US Citizens struggle or can simply not afford health care thus not having proper treatment for illness for themselves or their children. The Obamacare policy is a reform of the Patient Protection and Affordable Care Act that was passed by Senate in December, 2009. Shortly after in 2010, the house abandoned this reform bill and amended it into the Health Care and Education Reconciliation Act of 2010. Obamacare has many pros and cons and is so controversial that it makes headlines constantly. The pros to Obamacare I could go on about but I will hit a few. The major one is this unbelievable and rather sad...
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...Obama Care Obama Care Obama Care is thought by most people to be a US law aimed at reforming the American health care system. The main focus for this care is to provide more Americans with access to reasonable health insurance, improving the value of health insurance, regulating the health insurance industry, and decreasing health care spending in the US (Government, 2012). Many people have mixed feelings about Obama Care and how it is used in the US. In this paper, I will discuss the origins and the history of how Obama Care got started and its difficulties. Then, I am going to talk about the pros and cons dealing with Obama Care and the ways it will affect our economy. Next, I will discuss how Obama Care is funded and how there are still missing pieces that the administration needs to clear up. Lastly, I will argue how some of the American population thinks Obama Care is a scam. Then, to wrap up my paper I will be giving my opinion on this complex matter. Steps in the process of Obama Care The history of Obama Care is very complex but the name is the unofficial name for The Patient Protection and Affordable Care act, which was singed into law on March 23, 2010. The major requirements went into effect in January 1, 2014 even though significant modifications had happened before this date. Many Americans were opposed to Obama Care before it was even passed because they didn’t like the idea of the government taking over the healthcare polices. Now, I am going to...
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...main types of health insurance in the United States (Three Types of Health Insurance: Indemnity, Managed Care, Health Savings Accounts). Managed care plans are typically more cost efficient due to lower deductibles and copayments. However, patients can only choose from a limited number of physicians and hospitals (Three Types of Health Insurance: Indemnity, Managed Care, Health Savings Accounts). Indemnity plans are based on a “fee for service” system because patients are allowed the freedom to receive services from any hospital, doctor, and/or medical service (Three Types of Health Insurance: Indemnity, Managed Care, Health Savings Accounts). Indemnity plans have been utilized the longer than any of the other plans. However, one of the cons of the plan is that there is no cap on costs that may be incurred to the patient in any given period (Williams, 2008). Health savings accounts give patients to ability to save for future medical costs and/or pay for medical expenses being incurred in the present. Health savings accounts are tax free and composed of two parts: insurance and savings (Three Types of Health Insurance: Indemnity, Managed Care, Health Savings Accounts). Describe the three methods for categorizing health insurance in the U.S. The three methods for categorizing health care are as follows: true insurance against illness, organization sponsoring coverage, and funding mechanism. When utilizing true insurance a combination of products, including basic employee...
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... JANUARY 28, 2012 INTRODUCTION For more than seven decades, the United States healthcare system has improve significantly, compared to century ago and more has been done in terms of providing good healthcare an an antidotes to many disease process, this has been able to achieve due to the new healthcare technologies to tackle many diseases that were affecting citizens. In this modern day, it is apparently clear that the healthcare is one of the largest employer of labor according to the text (Williams and torrens, 2010) introduction to health services organization and management. The United States federal government have spent significant amount since the advent of Medicare in the country, in the late 1960s to date and this has rapidly grown to date. 1 – Identify and describe the three main types of health insurance in the U.S. The three main types of health insurance available in the U.S. today are voluntary health insurance, social health insurance and welfare medicine. Voluntary health insurance is subdivided into three categories. The first is Blue Cross Blue Shield which began as separate companies. Blue Cross began in 1929 and Blue Shield dates back to 1939, they joined each other in operation in 1982. Blue Cross Insurance can be found in every state within the U.S.Blue Cross Blue Shield is a privately owned company and is offered through...
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...Medicare is the United States' health insurance program for individuals age 65 or older. However certain people younger than age 65 can also qualify for Medicare, including those who are disabled, has permanent kidney failure or amyotrophic lateral sclerosis, known as Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Many Medicare participants must also have supplemental health care coverage in order to cover these charges that are not covered as part of the Medicare program. Is Medicare the perfect program? Well Medicare is financed by a percentage of the payroll taxes paid by workers and their employers. Also this program receives another percentage financed by premiums deducted from monthly Social Security checks. What is this Medicare crisis that everyone fears? The Baby Boomers are certainly growing older and even the youngest of these baby boomers are approaching 50 years of age. Retirement is getting closer but can this generation and the generations following count on the Medicare coverage that the past generations was fortunate enough to receive. Before more money was being saved then what was being spent for Medicare, and that extra money was put into the Hospital Insurance Trust Fund and the Supplemental Medical Insurance Trust Fund. Those funds total about $500 billion, all of it US Treasury bonds. However now thanks to the increasing number of individuals on...
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...signed into law on March, 2010. It has been the most significant repair to the United States healthcare since Medicare and Medicaid passed in 1965. In this paper, the key points that will be discussed are obamacare policy, it pros and cons, if it raises any issues with federalism and the policys effectiveness. Obamacare is aimed at helping the underinsured to gain insurance. With this plan everyone would have health insurance regardless of income, or anything that would stop the person from attaining health insurance. The Affordable Care Act is a watershed in U.S. public health policy. Through a series of extensions of, and revisions to, the multiple laws that together comprise the federal legal framework for the U.S. health-care system, the Act established the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement.(Rosenbaum, 2010) Obamacare is a name used by critics of President Obamas efforts to reform health care. Its a common term used to describe the Patient Protection and Affordable care Act of 2010. ObamaCare contains many benefits, especially for low and middle income families and businesses. ObamaCare also contains some obstacles for larger firm that dont insure their employees and certain aspects of the healthcare industry. The Pros and Cons boil down to this, Obamacare the average American has a lot to gain and little to lose, while some larger...
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...According to this article, the Congressional Budget Office (CBO) released an updated federal budget outlook for the next 10 year “budget window”, during the week of February 3rd, 2015. Detailed in this report were some revisions to the previous baseline projection for the effects of the Affordable Care Act (ACA). A more defined explanation and history of ACA: Federal health reform uses an approach that starts with the health insurance system we currently have in place in the United States. Health reform builds upon our current health insurance system to provide more people with access to health insurance coverage, establish legal protections for consumers, and set up mechanisms for consumers to shop knowledgeably for insurance. On July 14, 2009, House Democratic leaders introduced a 1,000-page plan for overhauling the US health care system, which Obama wanted Congress to approve by the end of the year. After much public debate during the Congressional summer recess of 2009, Obama delivered a speech to a joint session of Congress where he addressed concerns over his administration's proposals. In March 2010, Obama gave several speeches across the country to argue for the passage of health care reform. After Obama announced an executive order reinforcing the current law against spending federal funds for elective abortion services, the House passed the version of the bill previously passed on December 24, 2009, by a 60-vote supermajority in the Senate. The bill, which includes...
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...Analysis of Obamacare Health Policy Anthony E Davis POL201: American National Government Ginger Devine November 25, 2013 Analysis of Obamacare Health Policy One of the most crucial issues of today is the issue of health insurance and availability of quality health services to all residents of the U.S. This paper will analyze the Obamacare Healthcare Policy-highlighting its core elements, health care problem solution, and the policies history. Also it will evaluate the pros and cons using different perspectives in debate. Let’s begin with the elements of Obamacare. The Patient Protection and Affordable Care Act (PPACA), also called Obamacare or the Affordable Care Act, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 (ObamaCare Summary: A Summary of Obama's Health Care Reform, 2013). Since the establishment of Medicaid and Medicare of 1965, Obamacare is one of the most significant expansions from the government and administrative overhaul of the U.S healthcare system. The purpose of the Patient Protection and Affordable Care Act is to raise the rate of health coverage of Americans, to modernize the delivery of health care services, and to reduce the overall costs of health care. This is to be done by restricting certain insurance company practices and providing tax credits and subsidies for individuals and businesses. Prior to the approval of the Obamacare Policy, the American health care industry was in deep...
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...of imperfections. However, people need to be able to balance the good and the bad and not just focus on the bad. The Affordable Care Act offers many benefits, especially for the lower to middle income families and businesses. However, it has some obstacles for higher earners, and larger companies that do not insure their employees. One of the most noted pros to the ACA is their achievement in insuring millions of people with affordable, high-quality health insurance. Unfortunately, in order to get the money to cover these millions of newly insured people, taxes are increased, which directly affect us. You are now personally responsible to get health insurance coverage through the multiple companies that offer through the exchange. If you do not get coverage you have to pay a penalty fee. This adds more complications at tax time. However, with the new reform, many protections are in place to ensure that you can’t be dropped from coverage immediately whenever the insurance company decides you are getting sick too often. You also can’t be denied coverage or treatment for being sick or get charged more. I would say that is a big pro to the ACA. You can no longer be charged more for being a woman because you may need extra medical attention due to pregnancy or other yearly checkups. With that said, because insurance companies have to cover sick people, this increases the cost of everyone’s insurance. Another bonus to the ACA is the employer mandate which states that businesses with...
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...disagree with the “right” solution when it comes to Obama care, it is commonly agreed that there is a fundamental problem with the current healthcare system: nearly 50 million people in this nation are without insurance and those who are covered face high premiums with plans that do not cover the services they need. This current system is inefficient and therefore is poor quality and creates high cost. The ultimate goal of the legislation was to extend both private and public coverage to about 32 million people who were uninsured; to improve access to quality coverage for the uninsured; to improve how affordable coverage would be; and to ultimately reduce the overall growth in health care costs. Now for the pros and cons of this law, this was passed on June 29 2012. The pros of this law are that Patients with pre-existing conditions cannot be denied coverage by insurance companies, and companies can no longer drop someone once they get sick. This also means that if an insurance company denies someone coverage, that person can go to an external appeals process. “If the law is upheld, argued Verilli, “people with chronic conditions . . . will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty.” (Huffman 2012) It is also cost effective; the number of bankruptcies caused by health-related...
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...RUNNING HEAD: Week 6 Assignment #2 Week 6 Assignment #2 Strayer University Online November 13, 2014 Reforms for slowing the growth in health care spending and increasing the value of care have largely focused on insurance-based solutions. Consumer-driven health care represents the most recent example of this approach. However, much of the growth in health care spending over the past twenty years is linked to modifiable population risk factors such as obesity and stress. Rising disease prevalence and new medical treatments account for nearly two-thirds of the rise in spending. To be effective, reforms should focus on health promotion, public health interventions, and the cost-effective use of medical care. Disease prevention/health promotion approaches are key to slowing the rise in health care spending (Thorpe, Kenneth 2014). Over the past five years the cost of health insurance has risen 54 percent. This persistent rise has recently been attributed to the low out-of-pocket costs paid by consumers. Being oblivious to not knowing the full costs associated with health care, consumers demand more and “overuse” it (moral hazard). The growth in spending has also been linked to the rising use of prescription drugs and new medical innovations and treatments. Many others believe the rise can be traced to the lack of competition in the health care marketplace and have proposed new approaches for health plans to compete on price and outcomes. Economists thinking about...
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...Health care is driven by the health expenditures and monetary investments that come with bundled payments. As there are numerous methodologies in reimbursements and payment options the context of this paper will discuss how bundled payments work. What the pro and cons of a bundled payment system. The outline mechanisms underlying bundled payments and how it assists providers who are considering utilizing the payment options. As bundled payments are likely to become common in health care it is important as a future administrator to fully understand all aspects that come along with the payment system and how it will optimize and benefit your organization with a thorough understanding. The common usage of bundled payments in the healthcare system...
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