Kot Task 1
Running Head: KOT 1
KOT 1 Task 2
734.3- Organizational Systems & Quality Leadership
734.3.4: Healthcare Utilization and Finance
A1. MEDICARE PART A
The discussion with Mrs. Zwicks’s daughter about coverage requirements needs to be informative and easy to understand so she can help explain it to her mother. Medicare part A is hospital coverage for inpatient stays. This particular part of Medicare covers critical access hospitals, inpatient rehabilitation facilities, and long term care hospitals. It will also cover inpatient care in a skilled nursing facility, hospice, and some aspects of home health. Mrs.
Zwick was admitted to the short term acute hospital due to a stroke and it was necessary for her to be discharged to a skilled nursing facility for further care.
To determine the coverage Mrs. Zwick will have for her skilled care the requirements of the coverage need to be looked at. Due to the stroke and her inpatient admission, she required
critical access to care. She was admitted for five days so both factors met the criteria for coverage for Medicare part A. These included meals, nursing care, semi private room, any hospital services, supplies, and any possible mental health needs. Medicare part A has an annual deductible or co-insurance for the benefit period. Unfortunately, if the patient was traveling out of the country, no medical expenses would be covered under this part of Medicare.
Mrs. Zwick met the eligibility for coverage for admission to the skilled facility. There must be at least a three day stay at the hospital,. She was there five days, so she began receiving Medicare covered skilled care. Because she met the criteria, Medicare part A covered the skilled stay for the first 20 days. Medicare part A does not cover the co-insurance amount for each day after the twentieth day. Mrs. Zwick’s stay was 40 days so the patient and her daughter need to be aware the patient will owe
KOT 1 Task 2
734.3- Organizational Systems & Quality Leadership
734.3.4: Healthcare Utilization and Finance
A1. MEDICARE PART A
The discussion with Mrs. Zwicks’s daughter about coverage requirements needs to be informative and easy to understand so she can help explain it to her mother. Medicare part A is hospital coverage for inpatient stays. This particular part of Medicare covers critical access hospitals, inpatient rehabilitation facilities, and long term care hospitals. It will also cover inpatient care in a skilled nursing facility, hospice, and some aspects of home health. Mrs.
Zwick was admitted to the short term acute hospital due to a stroke and it was necessary for her to be discharged to a skilled nursing facility for further care.
To determine the coverage Mrs. Zwick will have for her skilled care the requirements of the coverage need to be looked at. Due to the stroke and her inpatient admission, she required
critical access to care. She was admitted for five days so both factors met the criteria for coverage for Medicare part A. These included meals, nursing care, semi private room, any hospital services, supplies, and any possible mental health needs. Medicare part A has an annual deductible or co-insurance for the benefit period. Unfortunately, if the patient was traveling out of the country, no medical expenses would be covered under this part of Medicare.
Mrs. Zwick met the eligibility for coverage for admission to the skilled facility. There must be at least a three day stay at the hospital,. She was there five days, so she began receiving Medicare covered skilled care. Because she met the criteria, Medicare part A covered the skilled stay for the first 20 days. Medicare part A does not cover the co-insurance amount for each day after the twentieth day. Mrs. Zwick’s stay was 40 days so the patient and her daughter need to be aware the patient will owe
References: Medicare Part A (Hospital Insurance). (2012). Retrieved July 28, 2012 from Medicare.gov. Medicare Part B (Hospital Insurance). (2012). Retrieved July 28, 2012 from Medicare.gov. Prescription Drug Coverage (Part D). (2012). Retrieved July 28, 2012 from Medicare.gov. Rademacher, L. (2012) E How Health. Retrieved July 29, 2012 from what is COBRA Coverage RAND Corporation Fierro, M. P. (2006). Trend Alert Costs of Chronic Diseases: What are the States Facing? Economy of the United States (2012) Health Care in Switzerland. (2012). Retrieved July 29, 2012 from Wikipedia the Free Encyclopedia. John Creighton Campbell, N.I. (2010). Lessons from Long-Term Care Insurance in Germany and Japan. Health Affair, 29(1), 87-95. Busse, R. (2004, May). Disease Management Programs in Germany’s Statutory Health Insurance System. Health Affairs, 23(3), 56-67. Health Care around the World: Great Britain. (2008, April 23) Retrieved July 29, 2012. Yosomono (November 29, 2009) “How to Navigate the Japanese Health System” gaijinass. Retrieved August 2, 2012.