medicare and medicaid

Medicare,Medicaid

IntroductionThepurposeofthispaperistogiveanoverviewoftwofederallyand/orstatefundedprogramsThe programsthatwillbediscussedareMedicareandMedicaid.Inthispaperwillbeinformationaboutwhoreceives Medicaid/Medicare,theservicesofferedbytheseprograms,andthoselongtermservicesthatarenotMedicaid Medicaidisajoi8ntfederalandstateprogram.Itprovideshealthcoveragetonearly60millionAmericans includingchildren,pregnantwomen,seniors,andindividuals...

MedicaidandMedicare

Unfortunatelyforthosepeoplewhocannotaffordservices,theyareleftwithnothingoreitherpoorcare,whichis unjustandjustshouldn'tbe.Therearemajorchallengesfacedbypolicymakerssuchastryingtocontrolthecost ofMedicaidspendingbecauseMedicaidisthebiggestpayeroftheseservicesPolicymakersmustensurethatthey arealsokeepingtheindividualservedfrontandforemostintheirdecisions.Ensuringthatqualityservicesaremet isonepieceofthepuzzleAsstated,unfortunately

ImpactsofMedicareandMedicaid

difficult.Inthearticle"SomeEldersMustTakeDrasticMeasurestoObtainLong-termCare",nationalmagazine journalistMaryA.Fischer(2011)statesthatmanyAmericansmustfacedemeaninganddisempoweringchoicesin ordertoqualifyforMedicaidorMedicare–federalfundedhealthinsuranceprograms–suchasrefusingtopayfora spousesinstitutionalization,divorce,andspendingdownassets.Theauthorarguesthatthesechoicesleavethe healthyspousewithdecreasedfundstoplanfortheirown

StatementofProblemMedicareandMedicaidaretwooftheUnitedStateslargestbrokensystems,whichmust sustainthemselvesinordertoprovidecaretotheirbeneficiariesBothMedicareandMedicaidarefundingbya jointeffortbetweenthefederalgovernmentandthelocalstategovernment.Ifandwhenthesegovernmentschoose tocutfundingorreducespending,MedicareandMedicaidtakethebiggesthitMostpeopleseethesetwobenefits asoneinthesame,twobenefitsthegovernmenttakes...

MedicareandMedicaidEssay

MedicareandMedicaidareprogramsthathavebeendevelopedtoassistAmericansinattainmentofqualityhealth careBothprogramswereestablishedin1965andarefederallysupportedtoprovidehealthcarecoverageto vulnerablepopulationssuchastheelderly,thedisabled,andpeoplewithlowincomes.BothMedicareand Medicaidarefederallymandatedanddeterminecoverageundereachprogram;botharerunbytheCentersfor Medicare&MedicaidServices,afederalagency("WhatisMedicare?...

TheForMedicareAndMedicaidServices

andmeaningfuluse(CentersForMedicareandMedicaidServices,2014)"Meaningfuluse"asdefinedby HealthIT.govconsistsofusingdigitalhealthrecordstoimprovequality,safety,efficiency,andreducehealth disparitiesItspurposeisto

COMPAREANDCONTRASTMEDICAIDANDMEDICAREMedicaidandMedicarearetwodifferent governmentprograms.Bothprogramswerecreatedin1965tohelpolderandlow-incomefamiliesbeabletobuy theirownprivatehealthinsuranceTheseprogramswerepartofPresidentLyndonJohnson's"GreatSociety"plan, acommitmenttohelpingmeettheneedsofindividualhealthcare.Theyaresocialinsuranceprograms,which allowthefinancialloadofpatient'sillnessestobesharedbyotherhealthy,sick,

MedicareandMedicaidOverview

MedicareandMedicaid:AnOverviewItisimportantthatweallunderstandthebasicsoftheMedicareand Medicaidprogramsaswewillalleventuallycomeofagewhereitisnecessarytoseektheirassistance.The purposeofthispaperistogiveabriefhistoryofhowtheprogramcameabout,thevariousplansforeachprogram, issuesthataffectcostandaccesstotheprograms,howthepoliticalarenaisaffectedandfinallyaconclusionwith finalthoughtsonthetotalinformationTheidea

ABriefNoteOnMedicareAndMedicaidServices

BothMedicareandMedicaidaremanagedbytheCentersforMedicareandMedicaidServices(CMS),whichisa divisionoftheUSDepartmentofHealthandHumanServicesMedicarewascreatedin1965whenpeopleof over65founditimpossibletogetprivatehealthinsurancecoverage.MedicareisaFederalhealthinsurance programthatpaysforhospitalandmedicalcareforelderlyandcertainindividualwithdisabilities.Theprogram consistsoftwomainpartsforhospitalandmedicalinsurance

WithLowIncome

programsthatprovidehealthcaretospecificgroupsofpeopleintheUnitedStatesknownasMedicaidand MedicareAfterPresidentJohnsonsignedtheSocialSecurityActin1965,thegovernmentcreatedthesetwo programs.Eachoftheprogramshavetheirowneligibilityrequirements,coverage,andcost.TheHealthcare reformeffectedbothprogramseligibilityrequirements,cost,andcoverageMedicaidprovideshealthcare insuranceforindividualsandfamilieswithlowincome.Thefederalgovernment...

ComparingMedicareAndMedicaidManagedCarePlans

ThepurposeofthispaperistothoroughlyexaminethesimilaritiesanddifferencesofMedicareandMedicaid managedcareplansbycomparingandcontrastingitsstrengths,weaknesses,incentives,commitmenttoaccess,and riskstotheconsumer.MedicaidandMedicarearebothhealthinsuranceprogramsfinancedandadministeredby governmententitiesandarebothequivalentintermsofthenumberofbeneficiariesandtotalexpenditures (McCarthy,Schafermeyer,&Plake,2011).Thesehealthcareprograms...

HealthCareSystems/Medicaid&MedicareEssay

Medicaid/MedicareServicesStellaWilliamsHarrisonCollegeMedicaid/MedicareServicesDevelopaplanforthe centerbyusingclinicalqualitymeasures,orCQMs,whicharetoolstohelptrackandmeasurethequalityofhealth careservicedthatareprovidedbyeligibleprofessionals,eligiblehospitalsthatarewithinthehealthcaresystem. Thesewouldbemeasurestousedatathatisassociatedwithprovidersthatareabletoprovidehighqualitycareor relatetolongtermgoalsforhealth...

TheHealthPlanForMedicareAndMedicaidServices

NeithertheAmericanHospitalAssociation(AHA)northeCentersforMedicare&MedicaidServices(CMS)had informationrelatedtotheaveragecosttocomplywithoneRecoveryAuditContractor(RAC)claimdenial; however,theAHA'sRACTracquarterlysurveyoffersvaluableinsightastotheRACcostshospitalsare accumulating.Ofthe1,165hospitalsthatrespondedtoRACTrac'sQ12014Survey,managingtheRACprocess costsnearly70percentofallhospitalsincludedinthissurveyinexcessof$10...

E-PrescribingisanIncentivebytheCentreforMedicare&Medicaid Services

E-PrescribingisanincentivebytheCentreforMedicare&MedicaidServices(CMS)Itallowstheelectronic transmissionofprescriptionsbetweenqualifiedmedicalpractitionersandphysicians.Theaimoftheprogramisto improvethedrugprescriptionsystembyavoidingerrorsresultingfromhandwrittenprescriptionsTheEprescribingprogramrunsonvariousstandards.ThesestandardsarespeltoutandaddedinPartDoftheMedicare PrescriptionDrug,Improvement,andModernizationAct2003(CMS

Medicare:MedicareAndMedicaid

Week2DBBilling2CompareandcontrastMedicareandMedicaid;includingfundingsources,fraudand/or abuse,andeligibilityrequirementsforrecipientsBothMedicareandMedicaidareadministeredthroughadivision ofHealthandHumanServicescalledtheCentersforMedicareandMedicaidServices(CMS)CMS'sprimaryrole istomonitorcontractorsandstateagencytoensuretheproperadministrationofMedicareandMedicaid.CMS establishespoliciesfortheproviderreimbursements,researches

ComparisonOfMedicaidAndMedicare

MedicaidandMedicarearegovernment-sponsoredhealthcareprogramsintheU.S.Theprogramsdifferinterms ofhowtheyaregovernedandfunded,aswellasintermsofwhotheycover.Medicareisaninsuranceprogram thatprimarilycoversseniorsages65andolderanddisabledindividualswhoqualifyforSocialSecurity,while Medicaidisanassistanceprogramthatcoverslow-tono-incomefamiliesandindividuals.Somemaybeeligible forbothMedicaidandMedicare,dependingontheircircumstances

ComparingMedicareAndMedicaid

anythingaboutMedicaidorMedicare.Withthisbeingsaid,Medicareisafederalprogramthatprovidesinsurance ifyouareovertheageof65orhaveaseveredisability,nomatteryourincomeMedicaidisastateandfederal programthatprovidesinsuranceifyouhavealowmonthlyincome(MedicareRightsCenter).Medicaidand Medicarearetwodifferentgovernmentrunprogramscreatedforolderandlow-incomepeople.Asaphysical therapist,patientsmayhaveMedicareorMedicaidastheirinsurance;

CMS–Medicare/MedicaidTheMedicareandMedicaidprogramsweresignedintolawonJuly30,1965by president,LyndonBainesJohnson.TheCentersforMedicare&MedicaidServices(CMS)isanagencywithinthe USDepartmentofHealth&HumanServicesinchargeofadministrationofseveralkeyfederalhealthcare programs.CMSisresponsibleforhealthcareprogramssuchas,theHealthInsurancePortabilityand AccountabilityAct(HIPAA),theClinicalLaboratoryImprovementAmendments(CLIA),andthe

TheExtension/RestrictionOfMedicaid/Medicare

Medicareisafederalprogramthatmakesanauthorizedprivilegetohealthbenefitsfortheelderlyanddisabled.It alsounderminestherightofworkerstocontroltheirretirementsavingsandthefreedomofelderstocontroltheir ownhealthcareOntheotherhand,MedicaidcreatesanentitlementtohealthbenefitsforthepoorWhileI realizedthatMedicaidandMedicarewerefederalprogramsofferedbytheU.S.government,Ididnotknow whethersomestatesexpandedorrestrictedMedicaid/Medicare

HistoricalLegislationMedicareandMedicaid

HistoricalLegislationfrom1965:MedicareandMedicaidLilianaMartinezDr.SmithGrandCanyonUniversity: HCA-4603/7/13HistoricalLegislationfrom1965:MedicareandMedicaidTheMedicareandMedicaidprograms weresignedintolawonJuly30,1965byPresidentLyndonJohnson("CentersforMedicare,"2012).Beforethis decisionwaseventakenintoconsideration,manyotherhealthcarereformshadpreviouslybeenintroducedby earlierpresidents,butfailedtopasstheSenateHealthcare

fundstwotypesofhealthplans:MedicareandMedicaidTheseareintendedtohelptheelderly,disabled,poor, andyoungTheseprogramshelpthosewhoareunabletopayforhealthinsuranceandcoverexpensesthatmaynot becoveredbytheirowninsurance.ThedisadvantageofhavingMedicareorMedicaidisthatnotalldoctorsaccept thisinsuranceandithasbeenlinkedwithreceivingsubstandardcarebythosecaregiverswhodoacceptthemThe basicMedicarepolicyisoftennotenoughcoverage...

Healthcare,Medicare,andMedicaidEssay

Healthcare,Medicare,andMedicaidTheUShealthcaresystemisascrutinizedissuethataffectseveryone: young,old,rich,andpoor.Thehealthcaresystemiscomprisedofthreemajorcomponents.Since1973,most Americanshaveturnedtomanaged-careprograms,knownasHMOsThesecondtypeofhealthcareofferedto AmericansisMedicare,healthcarefortheelderlyThethirdtypeofhealthcareisMedicaid,ahealthcareprogram forthepoor.Whyisourhealthcaresystemmade...

CurrentStateOfMedicareMedicaid

CurrentStateofMedicareMedicareenrolleesinUtahhavesavedabout$78milliononprescriptiondrugsdueto theACA.Coverageforbothbrandnameandgenericdrugswillcontinuetoincreaseuntilthecoveragegapis closedTheACAalsoallowsMedicarebeneficiariestoseekpreventiveserviceswithoutworryingaboutcost,due tothelackofdeductiblesandcopays.Thisaidsindetectingandtreatinghealthproblemsearlyon.InUtahin2014, 220,972individualswithMedicareusedfreepreventive...

Medicare&MedicaidServices(CMS)

Medicare&MedicaidServices(CMS)TheAffordableCareAct(ACA)signedintolawin2010,oneofthegoalof ACAistofocusonqualityofcareandtoprovideaffordablecareforthepeopleNotonly,itsfocusonimproving qualityofcarebutalsotoreducethecostsinhealthcaresystem.ThechangesinhealthcarehasenableMedicare& MedicaidServices(CMS)todevelopandtestnewmethodstoimprovethequalityofcareprovidedtoMedicare beneficiariesTheAffordableCareActhasenableMedicare

GroundlessFearsOfMedicareAndMedicaid

MedicareandMedicaidhasbeenprovidinghugebenefitsforseniorcitizensandlowincomefamilies.Theone questionnobodyseemstoanswerishowarewegoingtoaffordthistypeofinsurance?MayaRockeymooreargues inherarticle,"GroundlessFearsaboutMedicaidandMedicare,"thatweareabletoaffordthisaslongaswemake gooddecisionsRockeymooreclaimsthatweneedtokeepMedicareandMedicaidorourcountrywillfallapart Tostartwith,Rockeymooreusesametaphorwhenshesays...

BenefitsOfMedicareAndMedicaidEssay

concerningtheinsurancecover.WewouldliketoknowthedifferencebetweenMedicareandMedicaid.NURSE: Ohthat'sgoodtohearOkay,IwillstartbydefiningwhattheyareMedicareandMedicaidarebothgovernment sponsoredprogramsthataredesignedtohelpincoveringhealthcarecost.Medicareisaninsuranceprogramthat offersmedicalcaretothosepeoplewhoare65yearsandaboveOntheotherhandMedicaidisafinancialassisting programthathelpslow-incomeindividualsandfamilies...

CentersforMedicareandMedicaidServices(CMS)facessignificantchallengesinthecomingyearsKey populationsservedbyMedicareandMedicaidwillincreasedramaticallyoverthenext10yearsastheBabyBoom GenerationagesintoMedicare,moreAmericanslivelongerwithmorechronicillnesses,andthenumberof MedicaidenrolleesincreasesasaresultofprogramexpansionsundertheAffordableCareAct(ACA) (///citations///)Thecost,qualityofcare,andeffectivenessofbothMedicareandMedicaid

TheCenterForMedicareAndMedicaidServices

TheCentersforMedicare&MedicaidServices(2010)statesthatthefederalgovernmentinconjunctionwiththe AffordableCareAct(ACA)arepushingfortheintegrationofbehavioralhealthcareandprimarycarefor individualswithseriousmentalillness(SMI)AllOvertheNation,BehavioralHealthisBeingIntegratedinto PrimaryCareTheInstituteforHealthcareImprovementispartneringwithapproximately30organizations throughouttheUSTogether,theyareintegratingbehavioralhealth

Memo

RepresentativeHowardHughesFrom:Date:Re:PaneldiscussiononfundingMedicarecrisisMessage:Below pleasefindoutlineofcurrentMedicarecostconcernsaswellassomehistoryontheprogramaswellassomeplan optionstocuttingoverallcosts.Medicareisfacingamajorfinancialcrisis.Thefederalgovernmentsubsidizes medicalcareformorethan45millionelderlyanddisabledAmericansthroughMedicare.MedicareisthethirdlargestfederalprogramafterSocialSecurityanddefense

WeallhavethisconfusionbetweenMedicaidandMedicaresomepeopledon'tknowthedifferencebetweenthe twoordon'tevenknowwhateitherofthemareTheFederalgovernmenthastwodifferentprogramstoprovide healthinsurancecoveragetocitizensintheUnitedStates,whichareMedicareandMedicaid.Thetwoprograms, whilehelpfultothoseindividualswhoqualify,arenotavailabletoeveryoneI'mheretobrieflyexplainand discussthetwoprograms,theirsimilarities,andtheirdifferences...

It'sNoPlaceLikeHome

There'sNoPlacelikeHomeThereisnoplacelikehomeisawell-knownadagethatthehealthcareindustryhas recentlyembraced.AccordingtotheJointCommission,thehomeisthebestplaceforhealthcare,andithasproven tobenefitthepatientsinmanyways,becausethecostofcareislower,thepatientsarehappierandthe environmentisfriendlier(Dilwali,2013)CMSdefineshomecareas"prescribedservicesdeliveredinthepatient's homesuchasnursingcare;physical,occupationaland...

Medicare:HealthInsuranceintheUnitedStatesandSocialSecurity

Chapter7:1WhoiseligibleforMedicare?PersoneligibleforMedicareincludeindividualsagessixty-fiveand over,thosewithdisabilities,andthosewithend-stagerenaldisease(Hammaker,2011).herearethreebasic entitlementcategories:persons65yearsofageoroverwhoareeligibleforretirementunderSocialSecurityorthe railroadretirementsystem,personsunder65yearsofagewhohavebeenentitledforatleast2yearstodisability benefitsunderSocialSecurityortherailroad...

America'sLargestHealthInsuranceProgram

MedicareisAmerica'slargesthealthinsuranceprogramforthemenandwomenovertheageof65orwithcertain disabilitiesFormanyAmericans,thisahugepartofhowtheycanaffordmedications,doctorvisitsandother medicalexpenses.InrecentyearsthenumberofMedicareenrolleeshasdoubled(NASI,2015).The"Baby Boomers",peoplebornfrom1946-1965,isthelargestgenerationwithinAmericawithroughly75million AmericansThisgenerationofAmericansareallturning65aroundthesame

MedicareImpactOnHealthCare

whichenactedMedicareandMedicaid(CMS,n.d.).Originally,MedicarewascomposedofPartAandPartB.Part Aiscoversmoremedicalcostsassociatedwithhospitalstays,whilePartBcovermedicalcostssuchasdurable medicalequipment,nebulizers,somevaccinations(Pneumovax®,Zostavax®,andFlu),andsomenebulized breathingtreatmentsTheoriginalprogramwasdesignedtocoverdisabledindividualsandeveryovertheageof 65.ThelargestchangesthathaveoccurredtoMedicaretodatespawned...

MedicareIsAProgramCreatedByTheSocialSecurityActOf1965

MedicareisaprogramcreatedbytheSocialSecurityActof1965.Itisafederallyrunmedicalhealthinsurance programaimedatmedicalcoverageforseniorcitizensover65yearsofageOvertheyears,theprogramhas expandedtocoverotherbeneficiariessuchasindividualswithdisabilitiesandhasalsoevolvedtoaddprescription drugbenefitsTheprogramhasbeenimmenselysuccessfulinbringinghealthservicestomillionsofseniorcitizens andindividualswithdisabilities.Despitethis...

BenefitsOfMedicareAdvantage

IntroductionThefederalinsuranceprogram,Medicare(alsoreferredtoasTitle18oftheSocialSecurityAct1)was passedintolawin1965toprovidehealthcareforpeopleaged65andoverirrespectiveoftheirincome,health statusormedicalhistoryIndividualsunder65yearsbutwithpermanentdisabilitywerenotincludeduntilthe Medicareprogramwasexpandedin19722.Individualsofanyagethathavebeendiagnosedwithend-stagekidney disease(chronicrenalfailure)andrequiringcontinuous

MedicareIsAStateRunProgram

Medicareisnationalgovernmentrunprogramthatwasdevelopedin1965.Medicareprovideshealthinsuranceto Americansaged65andolderwhohaveworkedandcontributedtotheprogramthroughouttheirwholelifeby utilizingaround30privateinsurancecompaniesTheprogramalsoassistsinprovidingbenefitsforyoungerpeople withdisabilities.AswellasofferingMedicareintheUnitedStatesaprogramcalledMedicaidisalsoavailable. Whichisalsoagovernmentrunprogram,Medicaidisastate

GovernmentHealthInsuranceMedicaidandMedicare

GovernmentHealthInsuranceMedicaidandMedicareHCS/53103-16-2013Dr.DorothyCucinelliGovernment HealthinsuranceMedicaidandMedicareIntoday'ssocietyconcerninghealthcaretherearemanyaspectsThese aspectsarenotlimitedtotheprovider,thepatient,andthefinancialaspectTheaspectthatisfoundquite interestingisthefinancialaspect.Tobemorespecificaboutthefinancialaspect...

MedicareIsAFederalGovernmentProgramEssay

Medicareisafederalgovernmentprogramthatattemptstomedicallycoverindividuals65yearsandolderand thosewithpermanentdisabilities,themostdifficultpopulationtoserve.Forfiftyyears,Medicarehasprovided economicandhealthsecurityforolderAmericans,providingaccesstoessentialmedicalbenefitsincludingacute, chronic,andpreventivehealthservices.WhiletheimplementationoftheAffordableCareActimprovedMedicare byprovidingadditionalpreventiveservicesandbrand

LongTermCare

RaphaelÂ(2003)websiteÂstatestransitionsfromonesettingtoanotherarenotsmoothandbecauseofthe competitionbetweenproviders.Thishastoalottodowithhowtheygetpaidandwhatiscovered,andthathasto dowithMedicareandthelong-termcaresystemRaphaelÂ(2003),Â"theMedicarebudgetcutsstartedwiththe BalancedBudgetActof1997forcedproviderstofocusonfinancialsurvivalanddiscouragedexperimentation withnewmodelsofcareSecond,Medicare'snewprospectivepaymentsystems(PPS)

BenefitsAndBenefitsOfMedicare

MedicarepartAbenefitsapplyassoonasthepatientisadmittedtothehospitalandendwhenthepatientis hospitalizedfor60consecutivedaysAfter60days,thepatientwillberesponsibleforcopayfrom60daysto90 days.MedicarepartApaysforhospitalandskillednursingfacilitiesonlywhendeemedmedicallynecessary. Initialcopaymentisrequireduponhospitaladmittanceandseparatecopaymentisrequiredafter60dayswithina benefitperiodOncethepatientpaysthecopay,thehospital

TheHistoryOfMedicare,PoliciesAndProcedures

MedicareandMedicaidGeriseMartinezM320–PoliciesandProceduresAspenUniversityOctober2017  HistoryofMedicareandMedicaidTalksofnationalhealthcaredatebacktothedaysofPresidentRoosevelt,but didnotcomeintofruitionduringhisterm.In1945HarryTrumancalledCongresstocreateanationalhealth insurancefundforallAmericansandwasunsuccessfulThiswasanunsuccessfulfeatuntilLyndonJohnsonin 1965signedlegislationthatAmericansstartedreceivingMedicarehealth...

EssayaboutLong-TermCare

elderlywhoneedlong-termcareMedicare,thefederalgovernmentshealthinsuranceprogram,financesacute medicalcarefornearlyallelderlyAmericansovertheageofsixty-five.However,veryfewlong-termcare servicesarecoveredMedicarefinanceslong-termcareonlypartiallythroughit'slimitedskillednursingfacility (SNF)andhomehealthbenefits"Despiterecentgrowthinspendingonthesebenefits,muchoftheSNFand home-carepaidforbyMedicareremainsshort-termrehabilitative...

ElderlyCareForTheElderly

homecareTheaveragecostoflivinginanursinghomeis$84,000ayearandexpectedtobecomeevenmore expensiveastheyearsgoon.Annually,thecostoflivingforassistedlivingis$42,000.Whopaysforallofthis? Thegovernment(MedicaidandMedicare)helpspayforalotofthesecostsAnestimatedamountof632percent (whichis$131.4billion)ofthelongtermcarecostwascoveredbythegovernment...

StarkLawprohibitsself-referralsforMedicareandMedicaid,thereareexemptions;physiciansmayperformDHS servicesiftheyorderedtheservice.UndertheassumptionthatDr.VandDr.S.orderedtheservices,theywerenot inviolationoftheStarkLawThephysiciansofferedtosubleasethenuclearcameratothehospital,thiswasa violationoftheStarkLaw.UndertheStarkLawphysiciansareprohibitedfromcompletinganyactsunder MedicareandMedicaidthatareforfinancialinterestor

HealthCareEssay

HealthCareAmericahasahighlydevelopedhealthcaresystem,whichisavailabletoallpeople.Althoughitcan beverycomplexandfrustratingattimes,ithascomealongwayfromthehealthcareorganizationsofyesterday. Previously,mosthealthcarefacilitieswereaplacewherethesickwerehousedandcaredforuntildeath Physiciansrarelypracticedinhospitalsandonlythosewhowerefortunatecouldaffordpropercareathomeorin privateclinicsTodaythelevelofhealthcare

CaseStudyMedicareClaims

FraudCaseStudy:MedicareClaimsCarolannStanekUniversityofMaryFraudCaseStudy:MedicareClaims FalseclaimsareaparasitetotheAmericanhealthcaresystemresultinginoverallhigherhealthcarecostsThe DepartmentofJusticereportedrecovering$1.9billiondollarsinfiscalyear2015fromfraudulentandfalseclaims inhealthcare(DepartmentofJustice,2015).In2011,fraudandabusewereestimatedtoadd$98billiontofederal spendingforMedicareandMedicaid(Furrow,Greaney

helpthepatientsandtheirfamiliesfindthebestcollaborationofservicestomeettheirneedsDrugandhealth plansaremajorresourcestolong-termcareMedicaredoesnotcovermostoflong-termcareservices,butitmay payaportiondependingonselectedcoverage.Medicaidmaystepinandhelppayaswell."TheMedicarePlan Findertoolprovidesonecentralpointtoviewandcompareallavailabledrugandhealthplan

StarkLaw

ThiscreatesadilemmaforthestateasitcouldriskloosingthematchingfederalMedicaidfundsforsuchservices ifaviolationoccursForthepurposesofthisreview,IwillfocusonStarkIIPhaseIIIofthefinalrule(Continued) (Continued)TheStarkLawwascreatedtoaddressthegovernment'sconcernthathealthcaredecision...

TheImportanceOfHealthCareAmongElderlyAmericans

ThemostobviousreasonisthatMedicarerequiresanursinghomestaytomeetseveralconditionstobeeligiblefor coverageTheseincludethatthestaybeinaMedicare-approvedskillednursingfacility,whichexcludes intermediatecarefacilityservices,skillednursingcarebejudgedasnecessaryonadailybasisforthepatient's rehabilitation;

inplaceislongtermcaredeliverysystemforoldercommunityadultsdesignedtokeepthemintheenvironmentof theirchoiceaslongaspossible.Thiscaresystemincludesphysicians,nursesandotherprofessionals'tosupport olderadults'medicalfunctioning,functionalwellbeingandsocialsupporttomaintainthemintheirhomes (Popejoy,Galambos,Stetzer,Popescu,Hicks,Khalilia,Rantz&Marek,2015).Aginginplacehavetwofoldsof benefits:fromtheperspectiveofolderadultsandthe

TheIssueOfHealthcareFraudAndAbuse

Thepurposeofthispaperistobringawarenesstotheissueofhealthcarefraudandabuse.Ifeelthathealthcare fraudandabuseisoneofthebiggestissuesinhealthcare.So,thispaperwillgeteveryonetobeabletospotfraud beforeithappensDuring,theprocessyouwillbeabletoidentifywhatapersonorganizationdidthatwasfraudor howtheyabusedhealthcarerules.Thispaperwillexplaintoyouwhatexactlyhealthcarefraudandabuseisand howitaffectseveryonearoundusThroughout

JointCommissiononAccreditationofHealthcareOrganizations (Jcaho)

certificationreviewsonanunannouncedbasis,withcertainexceptions.In2008,TheCentersforMedicare& MedicaidServicesissuesaclarificationinOctober,soughtbyTheJointCommissioninresponsetofieldconcerns, whichbringsCMS'interpretationofstandingordersintoalignmentwithTheJointCommission'sviewonhowto facilitatethetimelytreatmentofcertainpatients.TheCentersforMedicare&MedicaidServicesgrantsTheJoint Commissiondeemingauthorityforcriticalaccesshospitalsin

First,it'scalledcontinuumcaresystem,itdealswithtrackingandkeepingincontactwithapatientovertimeand tofollowthemthrutheirhealthcareservicesThebreakdownofcontinuumcareisextendedcare,acutehospital care,ambulatorycare,homecare,outreach,wellnessandhousing.Itcouldfollowapatientfrombirthtotheendof lifeTheservicescouldbeacutehealthcare,hospital,emergency,inpatientservices,outpatientservices,urgent care,skillednursinghome,rehab,home...

FutureofSkilledNursingFacilities:MedicalModelvs.SocialModel

Introduction:WhilebeingemployedinCorporateAmericaforover20yearsandintheUnitedStatesAirForcefor over10yearshasbeenextremelyvaluableexperience,Idon'tfeellikeI'mfulfillingmypurposeinlife.After losingmygrandmother25yearsago,itfinallydawnedonmewhatmypurposeis,andthatistocareforouraging populationIamoneof65grandchildrenMygrandmotherandIalwayshadaspecialbondSheraisedmefora bigpartofmychildhood,andwasmoreofamother-figure...

LongTermCare

Thenecessityforlong-termcareisincreasingwhichwillrequireadditionaltrainingandeducationforhealthcare personnel,familymembers,andpatients.Familymemberscanhavepeaceofmindknowingtheirfamilymember willgainconfidenceinlearninghowtobecomeaccustomedtohisorhernewlifewhilemaintainingaquality continuumofcareduringandaftertreatmentforphysical,mental,orageassociatedillnesses.Long-termcareis alsoknownaspersonalassistantservicesandisdefined...

StarkLawisactuallythreeseparateprovisionsthatgovernphysicians'self-referrals,mostlyforpaymentby Medicarepatients;itisalsoknownas"theself-referrallaw""ThelawisnamedforUnitedStatesCongressman PeteStark,whosponsoredtheinitialbill("STARKLAW,"n.d.,para.1).Thefirstphasebecameeffectiveon January1,1992(Taromina,2013,p.83).Itprohibitedaphysicianfromreferringapatienttoaclinicallaboratory withwhichthey,oranimmediatefamilymember,hada

TheRoleOfTheJointCommissionOnAccreditationOfHospitals

Theroleofaccreditationinthehospitalsetting.ThehistoryoftheJointCommissiononAccreditationofHospitals isastoryofthehealthprofessions'commitmenttopatientcareofhighqualityinthe20thcenturyAccordingto Dr.ErnestCodman,founderoftheaccreditationsystem,whichwouldenablehospitalstotrackeverypatientit treatlongenoughtodeterminewhetherornotthetreatmentwaseffectiveIfnot,thehospitalwouldfigureouthow topreventsimilarfailuresinthefuture...

TakingaLookatLong-TermCareInsurance

IntroductionFormanypeopleyoungerthan50,long-termcareinsuranceseemslikesomethingtoworryaboutfor thefutureSomeyoungadultsfeelasthoughlongtermcareinsurancemaynotbeatopictodiscussattheirage becausetheyareyoungandhealthy.However,youngadultsshouldbethinkingaboutlongtermcareasearlyas possibleAswecanseeinhealthcarenewsandheadlines,long-termcarecostisrisingandfactorscanincludeyour age,medicalconditions,andoverallneedforcare...

EvidenceBasedNursingPractice:PressureUlcersEssay

EvidenceBasedNursingPractice:PressureUlcersJaneSmithResearchandScholarshipforEvidence-Based PracticeMarch10,2010Evidence-BasedNursingPractice:PressureUlcersTheprimarygoalsforconducting nursingresearcharetogeneratenewknowledgetopromotepositiveoutcomesforpatients,enhancequalityand cost-effectivenessofcare,improvethehealthcaredeliverysystem,andvalidatethecredibilityofthenursing...