...EFFECTS ON ENROLLMENT IN THE MEDICARE ADVANTAGE INSURANCE PLANS IN THE STATE OF TEXAS. Medicare is an insurance program provided by the federal government for people who are 65 years old or older, people of all ages with End-Stage Renal Disease, and certain disable people. Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Medicare has become America's leading health care insurance program, providing coverage for approximately 47 million individuals and costing more than $516 billion a year. Medicare nowadays is facing high popularity and an uncertain future. Some experts say that Medicare is expected to go bankrupt in 2017 (Clark, 2009). A Medicare Advantage Plan is another health coverage choice that eligible beneficiaries may have as part of Medicare. The plan is offered by private companies approved by Medicare. MA plans must cover all of the services that Traditional Medicare covers except hospice care. These plans are not considered supplemental coverage but may offer extra coverage such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage. Medicare pays a fixed amount for the beneficiaries every month to the companies offering the plans. These companies must follow the rules set by Medicare. The motivation to choose this topic comes from an internship or curricular practice training performed during the years 2010...
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...Supplemental Nutrition Assistance Program (SNAP) Abstract This article describes the benefits of the Medicare system while exploring the many challenges of the program. The United States Medicare program is the closest program to universal health care for one portion of the population. While providing some level of health care to most elderly citizens over 65 years of age, it sometimes is found to be highly confusing to its patients. Additional concerns explored by this paper relate to the costs, quality of care, and availability to all who need this insurance. When all of the pros and cons are explored, one final concern arises. Amid the rising costs of medical care, prescription drugs, and costs of program administration, will the funding of this program continue and will this be a program that the young families of today can depend upon for their retirement years? 1. Introduction: The rules and regulations of Medicare Simply stated, Medicare is the federally financed health insurance program for people aged 65 and over, certain individuals with disabilities, and individuals with end-stage renal disease. Medicare Part A covers hospital and other inpatient stays. Medicare Part B is optional insurance, and covers hospital outpatient, physician, and other services. Medicare Parts A and B are known as original Medicare or Medicare FFS. Medicare beneficiaries have the option of obtaining coverage for Medicare Part A and B services from private...
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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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...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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...This is one service that I believe would help the Krona Community Hospitals for their financial forecasting for their organization, which is National Health Service (NHS). This is a Healthcare System that is publicly funded for England. This is the largest system and the oldest single payer healthcare system in the world. This system has been funded through a general taxation system, this system will provide healthcare to every legal resident in the United Kingdom, which is with most services free at the point of use. This healthcare is at the point of use, which comes from the core principles at the funding of the National Health Service which is by the United Kingdom of labor Government in 1948. The free of point of use would mean that anyone that is legitimately has been fully registered with this system. Core Principles: · Will meet the needs of everyone · Will be free at the point of delivery · This will be based only on clinical needs not ability to pay From my research these three principles has been guided the development of the National Health Services over more than a century and it does remain. Now the main aims of these principles are that the National Health Services, which would provide is. · Will provide a comprehensive range of services · Will respond to the different needs of the different population · Will work continuously to improve the quality of their service · Will use...
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...Staff Date: January 18, 2015 Subject: Medicare Crisis Congressman Hughes, You have been asked to participate in a panel discussion concerning the Medicare crisis and how expenditures can be reduced. One proposal that is being considered is enrolling participants in HMOs. This memorandum contains information about the Medicare crisis and it will assist you in answering questions that the panel may have, and also aid you in making decisions concerning enrollment in HMOs. PROBLEM IDENTIFICATION The Medicare and Medicaid programs were signed into law on July 30, 1965, by President LBJ. When it was first implemented, Medicare covered most people aged 65 or older. "In 1973, the following groups also became eligible for Medicare benefits: persons entitled to Social Security or Railroad Retirement disability cash benefits for at least 24 months, most persons with end-stage renal disease (ESRD), and certain otherwise non-covered aged persons who elect to pay a premium for Medicare coverage." (Annual Statistical Supplement, 2011 - Medicare Program Description and Legislative History, 2011 para 2) Medicare consists of four parts: Hospital Insurance (HI), also Medicare Part A. Medicare part B is helps pay for physician, outpatient hospital, home health agency and other services. Medicare is Medicare Advantage Program which is a program that expands beneficiaries' options for participation in private-sector health care plans. Medicare D helps pay for prescription drugs that...
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...Update August 2014 RAC Program to Resume Limited Reviews this Month On August 4, 2014, the Centers for Medicare and Medicaid Services (CMS) announced that it would allow the Recovery Audit Contractor Program (RAC) to resume a limited number of reviews this month. The purpose of the RAC is to correct improper payments in Medicare claims for services provided to Medicare beneficiaries to ensure that proper payments are made on behalf of patients and taxpayers. The program has been dormant since the current Recovery Auditor contracts expired June 1, and CMS stated that the program has experienced continued delay in beginning modifications to the current contracts. CMS noted that there will be no impatient status reviews during...
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...Critical Analysis of a U.S. Healthcare Challenge - Fraud and Abuse HSM 420 - Managed Care and Health Insurance April 19, 2015 Professor Bob Vega Critical Analysis of a U.S. Healthcare Challenge - Fraud and Abuse Introduction 2 What is Fraud and Abuse 2 Cost of Fraud 2-3 How can fraud be detected in Medicare 3 What are the implications for fraud and abuse 3-4 How can it be prevented? 5 Summary 6 Conclusion 7 References 8 Increasing costs of healthcare is a fear for many families in America. An issue in the rate of healthcare insurance is deception. Fraud is frequently very problematic to identify. The scale of healthcare fraud is indefinite. Preliminary compensation and expense and billing timeframe of 90 days permits for quick reimbursement of services, however, many times before there is a warning of deceitful billing the company has shut down and moved on. Fraud in American healthcare will cost American’s millions, possibly even billions of dollars each year. Without hesitation, behind every action of fraud, is an interval in ethics. Fraud is the deliberate dishonesty or falsification that a person knows to be untrue or that they consider to be factual is not, and sorts, if they know that the dishonesty might cause in an unsanctioned advantage to themselves or someone else. The most common kind of fraud rises from an untrue...
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...Policy Analysis Assignment HA415 After reading the assigned scenario for Congresswoman Moody, it involves what options are available for her to ensure that medical care is available to everyone within her area of jurisdiction. There have been issues with funding and it is my job to having a structured policy analysis to the given situation. First step of a concise policy analysis is defining the problem. In this case, the funds allocated to these trauma centers are nearly exhausted and can potentially cause catastrophic effects on the areas patients. Soon the trauma centers will be refusing the patients who rely on Medicaid and Medicare resources. What can be done to prevent the refusal of healthcare to these patients and ensure that bailouts are not the solution to this healthcare crisis? To provide more in depth about this problem involves the background for a policy analysis. It has been stated that with numerous amount of undocumented workers and the state’s unemployment rate to continually remain high, it is making it difficult for these trauma centers to accept these patients. They rely soley on Medicaid which has caused a depletion of the state’s budget. This has caused two of the three trauma center to rely on private payer instead of federal aid programs. In the long run how can these HCO’s say they are providing quality effective healthcare to their people by denying it to certain groups? This will now lead us to the...
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...Medicare fraud is becoming a huge problem in today’s society. Medicare is a health insurance program for personnel paid by taxes the American population contributes to for personnel 65 years or older. When a health care provider, health suppliers, and private health companies deliberately bill Medicare for supplies or services that were not given is considered Medicare Fraud. To include, when a person uses another person’s Medicare card to receive health care for which the person does not qualify for. An individual, company, or a group can commit a Medicare fraud scheme. Medicare Fraud Scheme A physician, office manager for the physician’s medical practice, and five owners of health care agencies were arrested for charges related to the alleged participation in nearly a $375 million health care scheme. The Medicare Fraud scheme is the biggest in history. The scheme included fraudulent claims for home health care services. The physician, Jacques Roy, owned and operated Medistat Groud Associates P.A. in Dallas. The business included health care providers that primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the certification of more than 11, 000 individual patients from more than 500 Home Health Agencies from January 2006 to November 2011. Medistat certified more Medicare beneficiaries for health services and had more purported patients than any other medical practice in the United States. Basically, Dr...
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...Business Analysis Part 1 The company chosen for the business analysis is Humana, Inc. Humana, Inc is a health care company offering a wide range of insurance products from long-term care to well-being. Humana, Inc headquartered in Louisville, Kentucky. Humana defines their corporate social responsibility stating, “We are dedicated to making business decisions that reflect our commitment to improving the health and well-being of our members, our associates, the communities we serve, and our planet” (Humana, 2012) SWOT Analysis The SWOT analysis will cover Humana’s strengths, weaknesses, opportunities, threats, internal factors, and external factors. Humana’s internal factors are the strength and weaknesses of the company. Humana’s external factors are the opportunities and threats of the company. Humana’s strengths are the company has 400,000 -plus physicians on staff and 5,000 -plus hospitals throughout the United States and Puerto Rico. Humana offers a wide range of products to sell to the consumer. For individuals, the products are Humana One medical insurance, Humana dental, and vision insurance, financial protection plans, Rx drug plans, and Medicare plans. On the employer side of Humana’s products, they offer medical plans, spending accounts, dental and vision plans, disability coverage, life insurance plans, employer paid plans, and Rx drug plans. For the military Humana offers Humana Military Tricare programs. The military plans. The Tricare plans offer...
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...information about Medicare than social worker students about to enter the professional field. This should not be the case, students should be trained on information pertaining to Medicare so they can assist clients who need help with the Medicare process. I know that social worker is a broad field, but those who will be working with seniors should be familiar with the programs that benefit seniors. There were many areas where students answered “I don’t know” this is unacceptable in a field educators and advocates for the older population. They should at least know where to find resources about the information that they do not know. The Details The research will be conducted with five older adults suffering from chronic illnesses...
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...– Webliography Contribution Reforming Medicare in the age of Deficit Reduction Date: 04/16/2014 Webliography Contribution Entry / Reference 1: Urban Institute (2013). Can Medicare Be Preserved While Reducing the Deficit? Timely Analysis of Immediate Health Policy Issues. Retrieved from: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404766/subassets/rwjf404766_1 This reference help the current healthcare insurance and managed healthcare issues to reach the right set of policy to make changes that could correct long-standing gaps in financial protections that Medicare beneficiaries face, promote greater efficiency within payment systems, and generate the additional revenues necessary to pay for the impending surge in the number of beneficiaries. Entry / Reference 2: Steckenride, Janie, Parrott, Tonya (1998). New Directions in Old-Age Policies. The Health Care Policies and Older Americans. Retrieved from: http://books.google.ae/books?id=rwR4rpIrvW0C&pg=PA19&lpg=PA19&dq=Reforming+Medicare+in+the+age+of+Deficit+Reduction&source=bl&ots=ZtGKc36-o3&sig=00b8wDb48nxaR4uqWAHTms1slBU&hl=en&sa=X&ei=SKgJU77mK8eb0QW-44C4AQ&ved=0CDUQ6AEwAjgU#v=onepage&q=Reforming%20Med&f=false This reference help the current healthcare insurance and managed healthcare issues to explores the changed political environment in the United States and what it means for the policies and programs benefiting the elderly and their families...
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...two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and became law on March 30, 2010. Future reforms and ideas continue to be proposed, with notable arguments including a single-payer system and a reduction in fee-for-service medical care. The PPACA includes a new agency, the Center for Medicare and Medicaid Innovation, which is intended to research reform ideas through pilot projects. ------------------------------------------------- History of national reform efforts Here is a summary of reform achievements at the national level in the United States. * 1965 President Lyndon Johnson enacted legislation that introduced Medicare, covering both hospital and general medical insurance for senior citizens paid for by a Federal employment tax over the working life of the retiree, and Medicaid permitted the Federal government to partially fund a program for the poor, with the program managed and co-financed by the individual states. * 1985 The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment. * 1996 The Health Insurance Portability and Accountability Act (HIPAA) not only protects health insurance coverage for workers and their families...
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...communicate with one another as well as patients. Thus medical terminology plays an significant role in the area within the health care field. The terms that I will be going over in my own words are: Medicare, Medicaid, Certification (for physicians), public health, and ambulatory care. Medicare is a federally operated health coverage program that serves various individuals who have limited income and resources. Individuals who are of the age of 65 and older, those who are under 65 and permanently disabled, and any age group whom has end-stage renal disease (ESRD). The program is divided into four specific parts Medicare Part A, B, C, and D to cover heath services. Medicare Part A is a form of hospital insurance and covers inpatient hospital care. Medical Insurance is covered by Medicare Part B to cover physicians, and other health care services. The advantage of Medicare Part C is that this plan option that renders health coverage benefits from both Part A and Part B. Prescription drug coverage is provided from Medicare Part D. (Austin, 2008). Medicaid a federal and state funded program that provides health coverage for families, individuals, and those with disabilities. Depends on the recipient's income whether or not they qualify to obtain this form of care. The program varies from each state what services and benefits are offered. Most services include but not limited to physicians, impatient and out patient hospital services, laboratory, x-ray, and prescription drugs...
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