Medicare

President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act. The main provision of this legislative act was allowing Medicare coverage for outpatient prescription drugs. This was a well overdue benefit for Senior’s who spend an average of $2,322 per year on prescription drugs. President Bush proposal was to initiate private sector’s capacity to expand health care coverage while delivering quality medical services. Some Medicare beneficiaries felt this Act…

include pharmacy claims submitted by pharmacies to the Part D health plans for beneficiaries enrolled in Medicare Part D, which record prescription drugs identified by the National Drug Code, the date of dispensing, and the length of supply (also known as “days’ supply”). The use of the PDE data allows the present study to ascertain the starting time and duration of drug…

care management services, workers’ compensation administrative services and health information technology products and services (Aetna History). Per the company’s website Aetna has been recognized as one of the nation’s largest combined Medicare Advantage, Medicare prescription…

The CMS 1500 Claim Form is the standardized form used by non-institutional healthcare service providers who are seeking reimbursements from Medicare. It is responsible for the billing of claims generated for work performed by physicians, suppliers and other non-institutional providers for both outpatient and inpatient services It facilitates the process of billing by arranging diagnosis and services provided. “This information is attached to a claim form, which is submitted to insurance carriers…

Health Care And Capitalism Health insurance has always been a controversial issue in The United States of America. People pay health insurance so they would be taken care of in the event of emergency or illness. With the rising of medical attention in the US, and the insufficiency of wages, “ 33 million Americans, 10.4 percent of the U.S. population, still went without health insurance “(FiveThirtyEight). This gives rise to an important question: Is the American health care system a system…

The New Threat to Medicare, Medicaid, and Social Security This article explains about the controversial budget proposal supported by Representative Paul Ryan a Republican from Wisconsin. The bill “The Path to Prosperity: Restoring America’s Promise” was originally approved by the House of Representatives in 2011 but the Senate quickly overruled the bill along party lines. The main piece of the Ryan bill is the conversion of the defined benefits of Medicare to fundamentally a member…

“Professional etiquette is one of the most important factors contributing to a successful healthcare career,” (Britt, 2013). Webster defines professionalism as, “the competence or skill expected of a professional.” Webster also defines professional as, “following a line of conduct..” Therefore, performing actions under any sort of guideline while showing that you have the skill and the ability to do so is being professional. Professional etiquette far exceeds what patients witness. The…

The five elements relating to the establishment of a false claim under the False Claims Act are the government must determine that the claim was submitted falsely and that it was submitted with knowledge. The government must establish the claim was false and submitted knowingly, establish submitted claim to the person with actual knowledge, in considered ignorance, or with reckless disregard for the claim’s falsity, or truth. One of the other elements is that the element must be proven beyond a…

Reconciliation Act of 2010 (P.L. 111-152) which is the expansion of the Medicaid program. The original policy was created by Congress in 1965 and signed by President Lyndon Johnson, it was the concept of a universal health plan that combined both Medicare and Medicaid to serve the elderly (Policy Basics, 2015). The funding for this program was orchestrated in a way that allowed states to ramp up, in order to take on such an enormous financial burden, but numerous states chose not to expand…

any organization and they may differ based on the type of industry, its location, type of company, etc. However, for Medicare, the main fundamental drivers are as follows. Purpose The purpose of Medicare is to provide medical coverage for civil servants throughout the country. Its tagline “Mentakafulkan setiap warga penjawat awam”, is an attestment to this. On this note, Medicare needs to be innovative in introducing new competitive insurance products and at the same time find creative ways to…