Medicare Essay

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A. I would begin by telling Mrs. Zwick's daughter that it can be confusing trying to keep track of the different medical expenses and coverages, but reassure her that there are resources to help her. I would provide her with the Medicare.gov website as a resource to check for specific coverage. Regarding Mrs. Zwick's current medical expenses, her coverage would be as follows: Part A: Would cover her hospital stay at 100% after the first $1068 is reached. Her first 20 days of skilled nursing facility expenses would then be covered at 100%. Mrs. Zwick would then be required to pay a daily coinsurance for the additional 20 days of her skilled nursing facility stay. Part B: Would cover 80% of the durable medical equipment Mrs. Zwick requires upon discharge home. This would include her walker. Part D: Would be used to cover the medications Mrs. Zwick needs at home. The amount covered is dependent on a couple of factors; whether the deductible has been met for the year and what tier level the medications are in. If the deductible has been met, then the medications would cost a set copay depending on the medication. Medicare.gov could provide more information specific to Mrs. Zwick's plan. I would inform Mrs. Zwick's daughter that this is merely a basic break down of how Medicare works. She needs to be aware that before Medicare will cover any of the expenses they need to be approved by a Quality Improvement Organization. This is because the expenses are only covered if deemed "reasonable and necessary." B. Current Medicare policies could affect the reimbursement for any charges deemed as a result of the urinary tract infection. This includes the IV antibiotics, the additional days in the skilled nursing facility, and additional medications to take at home. Medicare no longer reimburses for hospital acquired infections. Since the hospital was not

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