Wgu Kot1 Task2 Essay

2760 Words Apr 20th, 2013 12 Pages
Task 2
Competency 734.3.4: Healthcare Utilization and Finance
A1-Which costs will be covered by Medicare Part A?
Medicare Part A is otherwise called the Hospital Insurance and covers up to 100 days of the Skilled Nursing Facility stay. To be qualified for it the patient first has to have been hospitalized for more than 3 days in a hospital (qualifying hospital stay) so the stay in it would not be considered outpatient. After the hospital stay the doctor that followed the patient in the hospital or the PCP that releases the patient from the hospital needs to write the order for the SNF services. In order for a patient to receive the services from the SNF they have to:
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In the scenario given, the list of the medications for the patient will be covered by her Medicare Part D, but the copays will have to be paid out of the pocket based on the TIER level.
B1a- Medicare policies affecting reimbursement.
On February 8, 2006 the Deficit Reduction Act of 2005 was signed by the president of the U.S.A. Section 5001(c) (CMS.gov,Centers for Medicare&Medicaid Services) of this Act requires identification of the conditions that:
-are high in cost, high in volume, or both
-could have been prevented via the application of the evidence base guidelines
- result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis. The reason for this identification and documentation is to promote or push hospitals towards better evidence –base practice resulting in a better and more cautious care. Based on the DRA, Medicare will not pay for Hospital Acquired Conditions if they were not present on the admission. The list for the HAC (Hospital Acquired Conditions) includes the following:
1. Foreign Object Retained After Surgery 2. Air Embolism 3. Blood Incompatibility 4. Stage III and IV Pressure Ulcers 5. Falls and Trauma (fractures, dislocations, intracranial injuries, crushing injuries, burns) 6. Manifestations of poor glycemic control, including diabetic ketoacidosis,

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