1. For non-provision of clear pricing information Mr. Lee pointed that we did not provide him with clear pricing information. In fact, during his first visit to our center, what we only know is whether his Bupa card can be used in our center and we have informed him about this. We would not know what can be covered by his insurance, how much Bupa will directly prepay for him, the agreed charge for this patient and whether his pre-authorization is successful until his pre-authorization confirmation letter was sent by Bupa to us.…
Covered the changes that have been put in place to simplify the enrollment process for both CHIP and the Medicaid programs. It address new options for community under the Medicaid program it covered the issue of dual eligibility and how payment will be coordinate. Tittle 3: Addresses Medicare reform strategies that are going to be implemented to save the Medicare program from the rising cost require maintaining the program. It covers many factors of the Medicare program effective date for improvement and evaluation strategies to help reduce cost and save the program. The goals are to improve the accuracy of payments improving the quality of services.…
In my opinion I think Bob Uecker is very deserving of the NAB hall of fame award. Bob Uecker has done a lot in his career to be awarded this award. Uecker was a retired player who returned to the Milwaukee Brewer's radio broadcasts position in 1971 and still until this day. For several years Uecker served for a color commentator for major networks like ABC in the early 1970s and NBC in the late 1990s. During that time of being on ABC he was help calling games and Uecker also did commentating for League Championship Series and World Series.…
The World Health Organization (WHO) maintains the International Classification of Disease (ICD). This system design is a healthcare classification system that provides diagnostic codes for classifying disease, sign and symptoms, abnormal finds, etc. The ICD-9 system has been in use for over 30 years now is replaced by ICD-10. The change from ICD-9 to ICD-10 has received much opposition from the United States as well as the medical industry. The benefits of using the ICD-10 are the in depth details of the new codes, a more accurate payment system for new procedures, fewer miscodes, and rejected improper reimbursement claims.…
APCD is a large-scale database system which collects health care claims data from different payer sources including most of health care providers. It combines data from all payers in a state, giving policymakers statewide information on costs, quality, utilization patterns, and both access and barriers to care, as well as numerous other health care measures. The purpose of such database is to make it publically available to consumers and purchasers as well, providing it as a comparison tool for price and quality as they make health care decisions. APCDs are proving to be helpful tools, filling longstanding gaps in healthcare information.…
Maryland managed Care website showed that there were eight different plans that a Medicaid recipient could choose from to receive their health coverage. Health Choice is the name of this statewide mandatory managed care program. The plans are Amerigroup Community Care, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, Med Star Family Choice, Priority Partners, Riverside Health of Maryland, and United Health Care. This paper will analyze these plans in terms of the benefits and coverage they offer, the cost of the service, the quality of the service and limitations within these plans. The plans will receive scrutiny in terms of how the coverage provided will attained the goals of healthcare reform, to provide access to health…
With a cost of about $269 billion annually, the Medicare program is now the second most expensive federal domestic program. It is very important for the Medicare program to begin the process of finding ways cut costs, while still sustaining the program and making it affordable to qualified individuals who are likely on a fixed income. One suggestion that will be explored in this paper is the idea of switching the entire Medicare program from the traditional insurance model to the managed care model which is currently only available with Medicare Part C. Firstly, one will need to thoroughly review Medicare C Medicare Advantage plans; this analysis will review what benefits have been realized by Federal government, providers, and ultimately patients since implementation. Seeing that Medicare Part C is currently using the managed care insurance model, it is time to take a closer look at its structure, along with its advantages and disadvantages. Expanding on the preceding statement will allow one to have the appropriate information to make an informed…
Introduction: What is the Health Care Reform Bill Act and how did it come into existence? In March of 2010, President Obama signed into law the Affordable Care Act (ACA), which is normally known as Obamacare is an endeavor at Health Care reform. Healthcare reform is thought to be required due to soaring costs, low quality of care, Americans lacking medical coverage and to put a stop to healthcare fraud (Assistant Secretary for Public Affairs , 2014). In this paper I will discuss the ACA projected timeline of changes, the key features of the law and what affect the changes has on employees and employers as well as how the law has affected organizations method toward benefit planning.…
There are so many things that can go wrong in programs that have to be used all over the country. There are some solutions to the program that can help maintain how things will work. This program is to understand how the professionalism that many people will try to take advantage of. It also will see how the patterns of payment will work. The program is to managed care how patients are spending their money at a fair price rate and not be taken advantage of.…
I’ve been helping my parents and grandparents on making great choices regarding their Medicare health plans. Before the Obamacare took effect, they are concerned about how the Affordable Care Act will affect their Medicare benefits. I briefly explained to them that as a Medicare beneficiaries that they are already covered, their benefits aren’t changing, and the marketplace doesn’t require them to do anything different. Also that their benefits are getting better. They should be able to pay less for prescriptions.…
Stewart, M.D. states, “the greatest problem we face today in the field of health care are the rising costs of health care…” (Stewart, 1967) As Medicare was only 18 months old back in July 1967, Dr. Stewart seemed to hit the nail on the head with his statement. With this being said, Medicare over the years has made a great impact and helped give coverage for the elderly, disabled, or those with ESRD – End-stage renal disease. Medicare is one of the largest, if not the largest, healthcare plans in the country and over the years since its inception there have been changes along to the way. To give an example, Medicare implemented a program known as IPPS, which stands for inpatient acute hospital Prospective Payment System, which was adopted in 1983 and payments were based on patient diagnoses not cost-based payments (CMS.gov,…
In 2014, state- and federally administered health insurance marketplaces were established to provide additional access to private insurance coverage, with income-based premium subsidies for low- and middle-income families, and federally subsidized expansion of Medicaid eligibility was made available in states choosing to participate. While it is too early to measure the impact of all of the various components of the ACA, studies already have found evidence that the number of uninsured adults has declined by about 9.5 million from July–September 2013 to April–June 2014 (Collins, Rasmussen, and Doty, 2014). Early evaluations of Medicare ACOs have also found promising results with regard to quality improvement and savings (CMS, 2014b). As of January 2015, Medicare will pay for doctors to coordinate the care of patients with chronic conditions. To be eligible for an extra $42 per patient, doctors will have to draft and help carry out a comprehensive plan of care for each patient who signs up for one.…
Introducing private plans created market based competition amongst healthcare plans providing better coverage at more affordable prices. The private market competition takes control away from politicians and bureaucrats dictating benefits/prices; into the hands of knowledgeable health care market experts in the industry. For the first time legislation put forth a fiscal safeguard in consistently measuring the Medicare Trust Fund in warning congress and the president when funds exceed 45%. This provides a foundation to keep adequate revenue levels above the threshold, provides warning, and creates opportunity in stressing improvement in improving the medicare…
Tricare Prime is a health maintenance organization (HMO) that services active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Beneficiaries choose a primary care physician (PCP) and for any specialty care outside the scope of their PCP secure referrals and authorizations (DHA 1). The offset for such limitations is a small copayments for each visit (retirees and their families only). There is an annual enrollment fee for Tricare Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members.…
Pull the trigger: the godber case: With the arising of consciousness for both Hong Kong people and official government towards the severe corruption, the whole society was waiting for a flashpoint to light up a new round of reformation. Peter Godber, the former chief superintendent of the Royal Hong Kong Police Force in Kowloon, a talented leader and a policeman who have done tremendously good work during the 1967 riots and had been decorated with the Colonial Police Medal for Meritorious Service in 1968, was found controlling assets over HK$4.3 million in 1973; those money altogether worth nearly six times of his salary between mid-1952 and mid-1973. According to the clause 10 in the Hong Kong anti-corruption law, he was given seven-day…