...be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not. Medicaid Medicaid is a joi8nt federal and state program. It provides health coverage to nearly 60 million Americans including children, pregnant women, seniors, and individuals with disabilities. As well as those people who are eligible to receive federally assisted income. Eligibility does however vary state to state. Medicaid may help pay for: Doctor bills, hospital bills, prescriptions, vision care, dental care, Medicare premiums, nursing home care, personal care services, in home care under the community alternatives program, mental health care, and services for children under 21. Medicaid can help pay for cost and services that Medicare doesn’t cover. In most states, Medicaid will pay for long term care services. In most instances they will cover services that will help and individual stay in their home such as personal care, case management, and help with laundry and cleaning. They won’t however pay for rent, mortgage, utilities, and/or food. Medicare “Medicare is the federal health insurance program for people who are 65 and older, certain young people with disabilities, and people with End Stage Renal Disease requiring dialysis or a transplant, and sometimes ESRD.” ( medicare.gov). There are four parts of Medicare that cover specific services: Medicare Part A, Part B, Part...
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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 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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...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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...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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...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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...services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare Beneficiaries, but Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s purpose is to prohibit a physician from referring a patient for designated health services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare...
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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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...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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...One of the things we will be talking about in the medical section is elderly women and Medicare. The passage of Medicare did not occur until 1966, which marked a key milestone in women’s economic security. It was also a huge influence to decreasing income equality between genders. Alina Salganicoff’s journal article “Women and Medicare: An Unfinished Agenda” written by mentions that “Today, Medicare serves 24 million women ages 65 and older, representing 56 percent of older adults enrolled in the program, and provides them with financial protection at a time in their lives when they have the greatest need for medical care and often the fewest family and economic resources” (43). This shows that almost 60% of women are covered by Medicare....
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...Memo To: Representative Howard Hughes From: Date: Re: Panel discussion on funding Medicare crisis Message: Below please find outline of current Medicare cost concerns as well as some history on the program as well as some plan options to cutting overall costs. Medicare is facing a major financial crisis. The federal government subsidizes medical care for more than 45 million elderly and disabled Americans through Medicare. Medicare is the third-largest federal program after Social Security and defense, and it will cost taxpayers about $430 billion in fiscal year 2010. Medicare is one of the fastest-growing programs in the federal budget, with spending likely to double over the next decade and to surpass Social Security spending by 2028. Numerous studies suggest that about one-third of Medicare spending is wasted. [ (Edwards, 2010) ] Many elderly people may believe that Medicare is an insurance plan as they pay into the cost and are charged for co-pays. Although it’s been known as welfare program, led by the government there is controversy regarding this. AARP Vise President, Joyce Rogers stated AARP is focused on protecting Social Security and Medicare for the millions of beneficiaries who have paid into the systems over their working lives. Rogers’ statement follows: “Medicare is not a welfare program. Seniors pay into Medicare their entire working lives based on the promise that they’ll have secure health coverage when they retire. Applying a means test...
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