...One of the things we will be talking about in the medical section is elderly women and Medicare. The passage of Medicare did not occur until 1966, which marked a key milestone in women’s economic security. It was also a huge influence to decreasing income equality between genders. Alina Salganicoff’s journal article “Women and Medicare: An Unfinished Agenda” written by mentions that “Today, Medicare serves 24 million women ages 65 and older, representing 56 percent of older adults enrolled in the program, and provides them with financial protection at a time in their lives when they have the greatest need for medical care and often the fewest family and economic resources” (43). This shows that almost 60% of women are covered by Medicare....
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...Medicare versus Medicaid A Brief Comparison Medicare versus Medicaid: A Brief Comparison The Federal government has two distinct programs to provide health insurance coverage to citizens, Medicare and Medicaid. The two programs, while helpful to those individuals who qualify, are not available to everyone. In this paper, I will briefly define and discuss the two programs, their similarities, and their differences. The first program I will discuss is the Medicare program. President Johnson signed Title XVIII of the Social Security Act, also known as Medicare, into law on July 30, 1965 with coverage beginning in 1966. When Medicare first began, it consisted of two basic parts, known as Part A, and Part B. Medicare Part A provides hospitalization coverage automatically to all citizens age 65 and older. It helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not have to pay a premium for this service because they or their spouse has already paid for coverage through payroll taxes. (Medicare Gen Info) For those who do not qualify for premium free service, an annual deductible of forty dollars per year was established. . Since then, like everything else, Medicare Part A premiums have increased. “The $1,024 deductible for 2008, paid by the...
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... Abstract The Medicare Prescription Drug, Improvement, and Modernization Act 2003, was signed into existence by President Bush on December 8, 2003. To approve the H.R. 1, the Medicare Prescription drug and modernization conference agreement, on November 22, 2003, the House of Representatives voted 220 to 215 and on November 25, the Senate voted 54 to 44 in order to approve the conference agreement. This Act over the years is intended to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare 2003. Health Policy The Medicare Prescription Drug, Improvement, and Modernization Act 2003, was signed into law by President Bush on December 8, 2003. To approve the H.R. 1, the Medicare Prescription drug and modernization conference agreement, on November 22, 2003, the House of Representatives voted 220 to 215 and on November 25, the Senate voted 54 to 44 in order to approve the conference agreement. This Act is created to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare 2003(Jennifer O’Sullivan, Hinda Chaikind, Sibyl Tilson, Jennifer Boulanger, and Paulette Morgan, 2003). Why were changes to Medicare deemed necessary? The changes are deemed necessary, because...
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...MEDICARE WESTERN GOVERNOR’S UNIVERSITY Medicare is the largest government payer covering those persons over age 65, and a subset of individuals under 65 that have disabilities or ESRD (end stage renal disease). Medicare is broken into categories like Part A which mainly covers hospital care; Part B which mainly covers outpatient and physician services and Part D which helps cover prescription costs. (CMS, n.d.). In order for hospitals to bill Medicare for services they must meet requirements stated in the conditions of participation. Section 482.11 of the Conditions of participation states that Hospitals must be compliant with federal laws and licensed with the state or other responsible party for licensing and that the hospital must also ensure that personnel are also licensed by applicable state laws. (ECFR, 2015). Section 482.22 of the conditions of participation goes on to say providers must be authorized by State laws and licensed in the state to work. (ECFR, 2015). Hospitals must undergo an inspection by state surveyors or hospitals can choose an accreditation agency such as The Joint Commission or The American Osteopathic Association/Healthcare Facilities Accreditation Program. These other accreditation agencies have been approved by CMS and are required to be equivalent or higher in their standards. (CMS, n.d.). The Affordable Care Act enacted a requirement that all Health and Human Service agencies develop quality standards. CMS further developed quality initiatives...
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...• Question #8 on page 486 at the end of chapter 16 Artie, Bella, and Carmen are Medicare Part D recipients. Artie currently has $1000 in prescription drug costs each year. Bella and Carmen have $3000 and $6000, respectively. Each has a mild case of insomnia and a new drug. Has just been introduced to treat their condition. It will cost $1000 per year. Which of the three is most likely to take the new drug? It is indicated that Medicare part D would cover 75% of the cost of the drug. Therefore, for Artie since adding the new drug would increase his expenditures from $1000 to $2000. The drug would therefore cost him an additional $250 out of pocket each year. Bella would have to pay a full $1000 out of pocket for the drug, since she is in the donut hole of coverage between $2500 and $5100 per year. Furthermore, Carmen is above the donut hole and would have to pay only $50 (5% of $1000) for the drug. Therefore, then Carmen would be the most likely to take it, than Artie or Bella. Carmen would most likely take the newer drug because it would be the cheapest option for her. Medicare would help cover the costs and she would have to pay $50. •...
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...Sequestration of 2013: Effects on Health Care Policy In the NIH, Medicare and CDC Written By Patricia Parrish Park University April 5, 2013 The largest concerns facing our president today are National healthcare reform and the budget. President Obama’s efforts over the past term have been caught at an impasse with a stale mate taking place between the political parties. As deadlines for budget cuts and proposals came and went without solution, certain budget tactics are put into place in order to control government spending. The most current tool is sequestering. Sequestration is a process of automatic, largely across-the-board spending reductions under which budgetary resources are permanently canceled to enforce certain budget policy goals (Spar, 2013). Because the health care system is such an immense part of the budget, healthcare will only come in second to the department of defense in the sizable amount of budget cuts (Levy, 2013). Many programs will be cut to include the National Institute of Health (NIH), Medicare, and the Center of Disease Control (CDC). The National Institute of Health’s budget is at $31 billion and will have to remove $1.5 billion from its funding. According to the NIH, this will slow scientific progress, delay clinical trials, and put a generation of young researchers at risk (Kaiser, 2013). Mikulski, senator of Maryland, fears that “the $1.5 billion cut at NIH will delay scientific projects, will make hundreds fewer research awards...
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...Women and Diabetes: An Examination of Quality of Care for Medicare Recipients Abstract In recent years, diabetes has become one of the top 10 causes of death among women. Research has revealed that women 65 years and older account for 40% of the population and numbers are expected to increase exponentially. Vigorous medication management and coordination of care is instrumental in treating diabetes effectively. The patchwork of health insurance that exist today, particularly Medicare Part D, is culpable in allowing unequivocal disparities among race, gender, and socioeconomic status. This paper will examine quality of care among Medicare beneficiaries, particularly women, and implications for revision in social policy. Maintaining an active and healthy lifestyle is a necessity for achieving longevity. A nutritional, well balanced diet coupled with regular exercise is a simple, yet effective way to sustain healthy living. Neglecting to address diet and exercise, as part of a weekly regimen, is a precursor to the onset of an acute, lifelong illness. Diabetes is one of the largest and fastest growing causes of chronic disease mortality, morbidity, and disability in the United States (Robbins & Webb, 2006). Currently, there is no vaccine to prevent diabetes and no cure for the disease once acquired. According to the American Diabetes Association, more than twenty-three million Americans have diabetes. Patients age 65 years or older account...
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...Affordable Care Act and Part D Kelly Ayers HCS/531 Monday 2 July 2012 Dr. Russell Arenz As the population ages, people want the security of knowing that they have health care coverage. At age 65, people have the opportunity to be covered by Medicare. Medicare has four parts to it; part A which is the hospital insurance, part B which is the medical insurance, part C is Medicare Advantage plan which offers extra coverage such as vision, hearing, dental and/or wellness programs, and part D is prescription drug coverage. The Patient Protection and Affordable Care Act survived a vote of the Supreme Court justices and changes will be implemented within the next few years. As people age and the number of people entering the golden years is growing, these people will be needing and using more health care than past generations. This paper will focus on the changes that will occur to close the gap in Medicare’s prescription drug “donut hole.” The “Donut Hole” of the prescription drug plan is the amount where the senior had to pay the price for the prescription until it reached the high end and Medicare took over again. The gap for prescriptions was reached at $2830 and after the cost of $6440 did Medicare coverage kick back in. “Once the total drug costs (what the plan paid and what the enrollee paid) reached $2830, enrouees went into the donut hole, where they paid the total cost of their drugs. This no-coverage feature continued until total drug costs reached $6440”...
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...Introduction On December 8, 2003, President Bush signed into existence the Medicare Prescription Drug, Improvement, and Modernization Act (CMS, 2003). This Act over the years is intended to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare (CMS, 2003). Why were changes to Medicare deemed necessary? The changes to Medicare where deemed necessary, because many seniors and elderly began to find that prescription medication necessary for their well being was out of reach due to costs (CMS, 2003). An overhaul of Medicare would reverse this; create affordable prescription medication, better and more affordable healthcare plans. Another reason for Medicare modernization was to reduce the overall expense of Medicare, because at the rate it was going, it was estimated that Medicare would run out of funds around 2026 . This bill would not only ensure that prescription medication was more affordable for seniors, but it would create competition, create choices for seniors, and would make Medicare more effective (CMS, 2003). This health policy aimed at providing $400 billion, which would help over 40 million seniors obtain prescription medication at an affordable price (Medicare, 2008). The prescription part of the bill, Medicare part D, began in 2006, and Medicare recipients pay a minimum of $35 per month, with a $250 deductible for prescriptions...
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...Medicare Exhaust Billing Procedure Manual Project Cynthia Gause Colorado Technical University Online ENGL205-1301 Technical Writing and Speaking Phase 4IP Contents Contents 1 Phase 1 IP 2 Procedure Manual Outline 2 Phase 2 IP 3 Procedure Manual Proposal (Revised) 3 Brochure 4 Brochure Continued 5 Phase 3 IP 6 Medicare Exhaust Billing Checklist 6 Procedure Manual 7 Preparing Bill 3 Step I – Census 3 Step II – Bill Upload 4 Exhaust Billing Claim Coding 5 Step III- Xclaim 5 DDE Step IV 7 Secondary Claim Submission 8 How to submit Secondary Exhaust Claim 8 UB04 Claim examples 8 Billing Reference Tools 10 Type of Bills 11 Patient Status Codes 12 DDE Access/ Menu 13 Phase 1 IP Procedure Manual Outline Outline for Medicare Exhaust Billing Procedure Manual I. Introduction This section will provide an overview of Medicare exhaust billing and the purpose of this manual. II. Bill Uploads Upload bill and billing data in the Ram system to allow bills to be created. III. Claim Coding, and required remarks Once bills have been uploaded and created, bills need to be coded correctly and remarks need to be added to the claim. IV. Submit Bill to Medicare thru Xclaim...
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...Healthcare Reform Questions & Answers for Employers Updated November 19, 2014 © 2014 GALLAGHER BENEFIT SERVICES, I NC . DISCLAIMER We share this information with our clients and friends for general informational purposes only. It does not necessarily address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues and application of these rules to your plans should be addressed by your legal counsel. Page i | © Gallagher Benefit Services, Inc. 2014 Contents BACKGROUND ......................................................................................................... 1 EMPLOYER RESPONSIBILITIES ......................................................................... 1 General ......................................................................................................... 1 1. Is there anything we have to do immediately? .................................................................. 1 2. Will I be required to offer health insurance coverage to my employees? .......................... 1 3. When will this requirement be effective? .......................................................................... 1 4. We have between 50 and 99 full-time employees (including full-time equivalents). Will we have to do anything in order to qualify for the delay until 2016? ....................................... 1 5. Our plan is self-funded...
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...Merck & Medco: A Comparative Analysis By: Larry Lloyd Keller Graduate School of Management FIN 561 Mergers & Acquisitions (Online) Professor Gene Smith September 19, 2015 Table of Contents Table of Contents…………………………………………………………………………………………………………………...i Executive Summary…………………………………………………..……………………………………………………………1 Overview of Pharmaceutical Industry…………………….…………………………………………………………......2 S.W.O.T Analysis..……………………..................................................................................................3-5 Impact on Marketing and Sales…………………………………………….………………………………………………..5-6 Marketing and Sales Considerations……………………………………………………………………………….........6-7 Operational Considerations………………………………………..…………………………………………….……………7-8 Financial Considerations………………………………………………………………………………………………………...8-9 Recommendations………………………………………………………………………………………………………………..9-11 References……………………………………………………………….…………………………………………………………….12 i. Executive Summary Merck & Co. is one of the world’s leading pharmaceutical companies, is seeking to acquire Medco Containment Services, a leading managed prescription drug benefit company, for $6 billion dollars. After the merger, Merck & Co. will seek to strengthen their position in healthcare industry, by not only selling prescription drugs used by millions of consumers, but also having a larger say in how the medicines are used by consumers...
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...legislation to establish the Medicare program as Title XVII of the Social Security Act. There are two types of coverage: Part A and Part B. Part A covers your hospital expenses and the services may require you to pay different deductibles and copayments. Most people qualify for Part A because they paid taxes for 10 or more years toward Medicare. Part B is your health insurance coverage and covers things such as doctor's office visits, x-rays, and outpatient surgeries. Other services offered are flu shots, yearly cancer screenings, and wheelchair or walkers to treat a disease or some type of condition. Most of the time you will end up paying a deductible and then 20% of an...
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...added to Medicare. Both George W. Bush and Al Gore have proposed a plan to expand Medicare to include full prescription-drug coverage for senior citizens receiving Medicare, at the expense of taxpayers. It is obvious why this issue has been such a priority for both candidates. Senior citizens vote at a much higher rate than other age groups. Both candidates know the importance of these senior citizen votes and believe that the proposal of adding a prescription-drug benefit is something that will appeal to a vast number of senior citizens. Both candidates have portrayed the issue as being very critical and as a serious problem that needs to be addressed. The question, however, is whether or not such drug coverage is a worthwhile project to undertake. Is the problem indeed serious enough to call for the type of reform that the candidates are proposing? Medicare is already a very costly program to keep up, and adding prescription-drug coverage would increase these costs even more. In order to fund this project, there will need to be a tax hike. Should taxpayers subsidize this prescription-drug benefit? Is there a good reason why this redistribution should take place? What are the benefits and costs of this proposal? These and other questions will be addressed in this paper as we examine the following topics: the need for senior citizens to have prescription-drug coverage, the political rhetoric involved with this issue, the projected shortfall in the budget of the Medicare program...
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... DR. TAMI RESIGNER Abstract In November of 2003, President George Bush signed a controversial law that had been passed into by the United States Congress. The new legislation made changes to Medicare that was necessary in order to make Medicare better for elderly and the disabled. Some felt like the changes was for the better, and some felt like the changes made Medicare worst. The paper that I will be presenting today is about the new Medicare plan that the U.S. Congress passed in November of 2003. This paper will be answering a couple of important question, that will farther help one to understand what Medicare was like from when it was first established in 1965, until the new changes came into effect November 2003. And the question will be answered in the following order. 1. Why was it deemed necessary to change Medicare? The reason why changes were deemed necessary in Medicare was because seniors began to notice that the medication that they needed for their health was becoming too costly for them to buy from the pharmacy. And this made the legislation wanting to change Medicare in order to make health care plans for the elderly more affordable, and the second reason was to cut the overall spending of Medicare, because it is said that the way it look if Medicare don’t reduce its spending, it will come to an end in the year of 2026(www.medicalnewtoday.com). 2. What was the main provision of the New Legislation? The new legislation main provision is to make...
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