The author will discuss the differences in Parts A, B, and D. Medicare Coverage Part A Medicare Part A is often called the hospital insurance because the coverage is primarily directed at hospital services. Part A covers inpatient care in a hospital, skilled nursing facility (SNF) and “Religious Nonmedical Health Care Institutions” ("Medicare Handbook," 2012, p. 27). In addition to this, Part A covers Home Health and Hospice care. This coverage includes all meals, a semi private room, medications administered during the inpatient stay and general nursing. The deductible that must be paid by the patient in 2013 is $1184.00.
Under this type of plan, a patient may see providers outside the plan, but the patient pays a higher portion of the fees: Preferred provider plan 12. Which of the following is mandatory for certain health professionals to practice in their field? Licensure 13. The National Practitioner Data Bank: Is accessible only to hospitals and health care plans 14. Licensure to practice medicine is done by: Each individual state 15.
Part A is the hospital insurance which helps pay for the in-patient care at a hospital or skilled nursing facility following a hospital stay, some in- home health care and hospice care. Part B is the medical insurance that helps pay for doctor visits and several other medical services and supplies that are not included by the hospital insurance. Part C also known as Medicare Advantage plan is like HMOs or PPOs and is offered by private companies approved by Medicare. The Medicare Advantage Plan provides all of Part A the hospital insurance, all of Part B medical insurance and may offer some extra coverage, such as vision, hearing, dental, and/or health and wellness programs as some include Medicare Part D, which is the prescription drug coverage. Part D is the prescription drug coverage that helps pay for doctor prescribed medications for treatment (Medicare, 2012).
Abstract Hospital accreditation is not the same as licensure or certification. Licensure is required to operate as a hospital and overseen by state government officials. Certification affords hospitals to participate in federally funded Medicare and Medicaid programs. Accreditation is defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve.” (Raik, 2001) For this case assessment I will discuss the role of accreditation as well as whether or not accreditation is mandatory. Finally I will discuss any weaknesses inherent in the healthcare accreditation process.
There are different types of healthcare delivery systems available to meet the need of each patient. The United States is very unique when it comes to the system of healthcare delivery. Most countries that are developed have national insurance programs that are controlled by the government and financed through general taxes. Americans in the U.S. however are not automatically covered by health insurance. There are however various health care services in the United States designed to ensure that quality healthcare be given based on the patients’ illness and financial background.
In this journal, I will be reflecting about how insurance companies, hospitals, and patients can use Cost-benefit analysis for sustaining a life. First and foremost, Insurance companies routinely use cost-benefit analysis in healthcare to set policies and decide whether to approve claims. Many companies have blanket policies on general treatments, to either approve or deny them. If the cost is unacceptably high and the benefit is marginal or low, the company may deny treatment. In the event of an appeal, it can perform a more rigorous analysis of the situation.
Most people have a managed healthcare plan through an employer or self employment. Premiums are paid on the insured’s behalf for the purpose of covering healthcare costs. The two major healthcare plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Health Maintenance Organization (HMO) is an organization that provides healthcare coverage through hospitals, physicians, and other providers which are contracted by the HMO; this type of insurance coverage only pays for services rendered by physicians and other providers who are within the network and have agreed to treat patients according to the guidelines of the HMO contract. The HMO plan is usually less expensive because the patient is limited to certain providers.
Other users might include lawyers, employers, law enforcement and researchers. Government licensing agencies make policies that have been determined from the analysis of aggregate data gathered from medical records, in federal and state databases. Institutional users such as hospitals or clinics, depend on the Data Quality Management Model for adequacy and appropriateness of care determined by medical review organizations and the effectiveness of healthcare services reimbursement guidelines enabling the coding and billing departments to receive payments for their services. Research organizations use data to aid in experimental patient care and keep
* Identify key macroeconomic variables that affect your industry. * Consumption- in today’s society the health care industry provides health care services to individuals by * Output- * Unemployment/ uninsured- * The health care industry is affected by individuals not being covered by insurance. This results in people who really needing health care services and not being able to pay for them. If individuals are laid off or not working they may not have the disposable income to pay for treatment, medicines or other services provided. Health insurance plans pay doctors, hospitals and other providers in various ways such as fee for service, bundled payments or a fixed amount for all services that a patient may receive over a period of time.
Features of Health Plans Major Types of Health Plans Indemnity plan, health maintenance organization, point-of-service, preferred provider organization, and consumer-driven health plans are the five major types of health plans. All of these health plans have similarities and differences, but some are better for consumers and the others are better for providers. The indemnity plan indemnifies the policyholder against the cost of medical service and procedures as listed on a benefits schedule, but the patients can choose the provider that they want to see. Health maintenance organization (HMO) has their own network of physicians, hospitals, and other providers by negotiating contracts with them. Consumers who have HMO pay a premium for coverage on medical cost and delivery of health care.