Comparison of Health Plans Allison Hershberger HCR/230 September 22, 2013 Jill Frawley Comparison of Health Plans PPO stands for preferred provider organization and is a managed care organization of medical doctors, hospitals, and other health care providers who have a binding agreement with an insurer or a third-party administrator, which usually pay participating providers based on a discount from their physician fee schedules, called discounted fee-for-service (Valerius et al, 2008). Providers in the PPO will provide the insured members of the group a substantial discount below their regularly-charged rates. These arrangements help to ensure that the insurer will be billed at a reduced rate when it’s insured utilize the services
What payment methodologies does the CMS use? The center for Medicare and Medicaid Services use the prospective payment system (PPS). The PPS system is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities.
Finally I will discuss any weaknesses inherent in the healthcare accreditation process. I will use course provided material and personal research to make my case. Hospital Licensure, Certification and Accreditation 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.
2. Discuss the effects of the Welfare Reform Act on Medicaid eligibility. 3. Explain the difference between categorically needy and medically needy. 4.
1: Should the information pertaining to actual claims incurred as of the balance sheet date that became available after the balance sheet date be considered in determining management’s best estimate of the medical benefits payable? If so, how does this information impact the amount recognized or disclosed? We identified that the information pertaining to actual claims incurred as of the balance sheet date that became available after the balance sheet date should be considered in determining management’s best estimate of the medical benefits payable. ASC 450-20-25-6 states, "After the date of an entity's financial statements but before those financial statements are issued or are available to be issued (as discussed in Section 855-10-25), information may become available indicating that an asset was impaired or a liability was incurred after the date of the financial statements, or that there is at least a reasonable possibility that an asset was impaired or a liability was incurred after that date. The information may relate to a loss contingency that existed at the date of the financial statements."
Each year the Trustees of the Social Security and Medicare trust funds report on the current and projected financial status of the two programs. This message summarizes our 2012 Annual Reports. The long-run actuarial deficits of the Social Security and Medicare programs worsened in 2012, though in each case for different reasons. The actuarial deficit in the Medicare Hospital Insurance program increased primarily because the Trustees incorporated recommendations of the 2010-11 Medicare Technical Panel that long-run health cost growth rate assumptions be somewhat increased. The actuarial deficit in Social Security increased largely because of the incorporation of updated economic data and assumptions.
The major components of pension expense b. The amount paid from the pension fund to retirees during the period c. The funded status of the plan and the amounts recognized in the financial statements d. The rates used in measuring the benefit amounts 56. The main purpose of the Pension Benefit Guaranty Corporation is to a. require minimum funding of pensions. b. require plan administrators to publish a comprehensive description and summary of their plans. c. administer terminated plans and to impose liens on the employer's assets for certain unfunded pension
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.
1) Medicare was established by Congress in 1966 to provide financial assistance with medical expenses to: a) people over 65 b) people with ESRD c) people under 65 with disabilities d) all of the above 2) Medicare requires its beneficiaries to pay premiums, deductibles, and coinsurance, which is referred to as: a) Medigap b) taxation c) cost sharing d) allowable charges 3) Medicare Part A, the hospital insurance part of Medicare, is funded through: a) taxes withheld from employees’ wages b) taxes paid by employers c) state funds d) both a and b 4) Coverage requirements under Medicare state that in order for a service to be covered, it must be considered: a) proper and timely b) reasonable
Costs and benefits of intervention are evaluated in terms of public willingness to pay for pay benefits and pay to avoid costs. Inputs are typically measured in terms of opportunity cost Process=monetary value of initial and ongoing expenses vs. expected returns. Cost effective analysis A number of approaches are available to understand the economic costs and impact on health outcomes. The most common type of economic