Preview

Kot Task 2

Better Essays
Open Document
Open Document
5017 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Kot Task 2
Medicare part A is hospital coverage for inpatient hospital stays. More specifically, Part A is coverage for critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. Part A also covers inpatient care in a skilled nursing facility (not supervisory or long-term care), hospice care services and some home health care services. Inpatient care in a Religious Nonmedical Health Care Institution is also covered. In the scenario provided, Mrs. Zwick is admitted to the hospital as an inpatient because she had a stroke. The patient was deemed by the physician to need continued treatment after discharge due to the patient 's condition and was discharged to a skilled nursing facility.
To determine what coverage Mrs. Zwick will receive from Medicare Part A, one must look at the coverage requirements. Due to a stroke, the patient was admitted inpatient and needed critical access to care. The patient was only an impatient at the hospital for five days. These factors fit the criteria for Medicare Part A coverage for a semi-private room, hospital services, meals, nursing, and supplies, and inpatient mental health care (lifetime limit of 190 days). Medicare part A does not pay the annual Part A deductible amount; and the co-insurance amount that is $1,156 per benefit period. Since the patient was admitted for only 5 days, the patient only has to pay one benefit period. If the patient had needed blood, the cost of the first three pints of blood would not be covered. Moreover, if the patient had been traveling abroad no medical expenses would have been covered under Medicare Part A.
For the patient to be eligible for SNF coverage post discharge, the patient had to have either had a qualifying three-day hospital stay or started receiving Medicare-covered SNF care. Because the patient met this criterion, Medicare Part A covered the SNF stay for the first 20 days of her stay based on Medicare Part A coverage stipulations.
What Medicare Part A does



References: Busse, R. (2004, May). Disease Management Programs In Germany’s Statutory Health Insurance System. Health Affairs, 23(3), 56-67. Economy of the United States. (2012). Retrieved May 22, 2012, from Wikipedia the Free Encyclopedia: http://en.wikipedia.org/wiki/Economy_of_the_United_States Fierro, M Health Care Around the World: Great Britain. (2008, April 23). Retrieved May 18, 2012, from Healthcare Economist: http://healthcare-economist.com/2008/04/23/health-care-around-the-world-great-britain/ Healthcare in Switzerland John Creighton Campbell, N. I. (2010). Lessons from Public Long-Term Care Insurance in Germany and Japan. Health Affair, 29(1), 87-95. Medicare Part A (Hospital Insurance). (2012). Retrieved May 20, 2012, from Medicare.gov: http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-a.aspx Medicare Part B (Medical Insurance) Medicare Prescription Drug Coverage (Part D). (2012). Retrieved May 15, 2012, from Medicare.gov: http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx Rademacher, L RAND Corporation. (2002). The Health Risks of Obesity Worse Than Smoking, Drinking, or Poverty. Retrieved May 15, 2012, from RAND Corporation: http://www.rand.org/pubs/research_briefs/RB4549/index1.html Torrey, T World Health Organization. (2005). Preventing Chronic disease is a Vital Investment. Retrieved May 13, 2012, from World Health Organization: http://www.who.int/chp/chronic_disease_report/full_report.pdf

You May Also Find These Documents Helpful

  • Satisfactory Essays

    3-If this claim had fallen under the Medicare deductible, would the secondary insurance pick up the change?The secondary payer which it is your second insurance may not pay all the uncovered costs it all depends on you primary they may pay the left part from…

    • 112 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    The notes also state that Hospital needed to receive a medpay exhaustion letter in order to submit the claim to the patient’s health insurance. The source of this requirement is not stated. On May 21, 2014, Community Care informed Hospital that the patient’s coverage had terminated and stated that the 120 day timely filing period had expired. On July 30, 2014, Hospital finally submitted a UB-04 to Community Care as the secondary payor, which was 266 days after the patient was discharged. On September 17, 2014, Community Care denied the claim for timely filing. The total billed charges are $59,819.44. Because the hospital does not participate in Community Care’s network, it is unclear what the expected payment would…

    • 843 Words
    • 4 Pages
    Good Essays
  • Good Essays

    In the article Medicare Under Observation, it is mentioned how unfair and ineffective the Affordable Care Act is for senior citizens in the United States. The article emphasizes on a letter written by a Medicare beneficiary who recently had gone to the emergency room to get treatment for a urinary tract infection and ended up having to stay for hours only to be told he was not going to be able to go home and he was being admitted into the hospital for observation which he claims that under the Affordable Care Act law Medicare will not pay anything on. This left him very puzzled and wondering how come he needed to stay over a period of two to three days. This being the case, he would have to be responsible for paying this medical bill in full…

    • 358 Words
    • 2 Pages
    Good Essays
  • Powerful Essays

    Kot Task 1

    • 2250 Words
    • 9 Pages

    least a three day stay at the hospital,. She was there five days, so she began receiving Medicare…

    • 2250 Words
    • 9 Pages
    Powerful Essays
  • Best Essays

    hca302 template

    • 1807 Words
    • 6 Pages

    References: Rodwin, V. G. (2003). The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. In NCBI. Retrieved September 28, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/…

    • 1807 Words
    • 6 Pages
    Best Essays
  • Powerful Essays

    The Medicare program has two components: Hospital Insurance (HI) or Medicare Part A, helps pay for hospitalizations, home health, skilled nursing facilities, and hospice care for the aged and disabled. Supplementary Medical Insurance (SMI) consists of Medicare Part B and Part D. Part B helps pay for physicians, outpatient hospital care, home health, and other services for the aged and disabled who have voluntarily enrolled. Part D provides subsidized access to drug insurance coverage on a voluntary basis for all…

    • 2917 Words
    • 12 Pages
    Powerful Essays
  • Satisfactory Essays

    This question is difficult to answer for me because I have been in and out of the program for various reasons over a number of years and originally began the program in 2007 right after I got out of the Navy, so I failed to pay much attention to the health care industry at the time to be honest. At the time I was going through some personal struggles that over road all my other trains of thoughts because they affected my life so insanely. In 2006 my medication prices doubled without insurance. Thank God that Publix started giving certain antibiotics out for free with prescriptions during the cold season. They were working on a plan in legislature to make medicine easier to afford. Frencher (2006), “The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) provides universally available prescription drug benefits to elderly and disabled Medicare beneficiaries for the first time” (para. 1).…

    • 308 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Medicare is a national social insurance program, administered by the U.S. federal government since 1965 that guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal 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. Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks. The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. When first implemented in 1966, Medicare covered only most persons age 65 and over (Social Security Administration, 2012).…

    • 610 Words
    • 3 Pages
    Satisfactory Essays
  • Powerful Essays

    Scott, J. S. (1999). Universal health care revisited. Healthcare Financial Management, 53(6), 32-33. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/196359014…

    • 1337 Words
    • 6 Pages
    Powerful Essays
  • Powerful Essays

    References: Abood, S. (2007). MEDICARE FROM THE START TO TODAY . Retrieved June 6, 2011, from National Bipartisan Commission on the Future of Medicare: http://thomas.loc.gov/medicare/history.htm…

    • 1496 Words
    • 6 Pages
    Powerful Essays
  • Better Essays

    Medicare is a federally funded health insurance program that provides coverage and benefits to nearly 50 million seniors and individuals with disabilities. If it were not for the assistance of Medicare, millions of Americans would not be able to afford testing, preventative services, hospital stays and physician care that is provided under this program. (National Women’s Law Center, 2012). In order to implement the policies that allow specific coverage to the beneficiaries under Medicare, there are three stages that must be followed: the formulation stage, legislative stage, and the implementation…

    • 1346 Words
    • 6 Pages
    Better Essays
  • Good Essays

    Home Health Vs Hospice

    • 579 Words
    • 3 Pages

    In home health and hospice, services are covered 100% by Medicare and care is taken place in the patient’s home. Medicare covers medications, supplies, skilled nursing visits, hospice care aides, social workers, and chaplain and bereavement services in hospice. Home…

    • 579 Words
    • 3 Pages
    Good Essays
  • Powerful Essays

    Medicare Overview

    • 1393 Words
    • 6 Pages

    The different parts of Medicare consist of the following: Part A is hospitalization, which is…

    • 1393 Words
    • 6 Pages
    Powerful Essays
  • Satisfactory Essays

    Medicare Polcy

    • 622 Words
    • 3 Pages

    Lubitz, J. (1998). Three decades of Health Care use by the elderly, 1965-1998. Retrieved on…

    • 622 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    Medicare is for those 65 years of age who are eligible for social security and have paid in to Medicare. Medicare consists of two types of coverage, part A and B. Medicare part A is the hospital insurance, while Medicare part B is the supplementary medical insurance Part A insurance helps with hospital care, nursing home care, home health care, and hospice care. Part B supplemental…

    • 850 Words
    • 4 Pages
    Good Essays