Healthcare Utilization and Finance
WGU
Organizational Systems &Quality Leadership
KOT1
Lynnell Fulkerson

Healthcare Utilization and Finance
Medicare
A1. Medicare Part A

Medicare Part A covers medically necessary services and supplies including hospitalization

and skilled nursing facility (SNF) care. Mrs. Zwick spent five inpatient days in the hospital and

40 days in a SNF. Medicare Part A will cover 100% of the first 60 days of Mrs. Zwick’s hospital

stay after she pays the $1,184 deductible. Because Mrs. Zwick spent at least three days as an

inpatient in the hospital, and assuming that the skilled nursing facility Mrs. Zwick

is admitted to is Medicare certified, Medicare Part A will pay for 100% of her first 20 days in

SNF (2013 Medicare Costs, 2012).

Medicare Part A also covers days 21- 100 in a SNF with a $148 per day co-pay, however, Mrs.

Zwick had a hospital-acquired infection (HAI) of the urinary tract and was unable to participate

in rehabilitation for 7 days. Medicare will not cover the costs of those 7 days in the

SNF because in 2009 the Centers for Medicare & Medicaid Services (CMS) stopped paying for

preventable conditions including hospital-acquired urinary tract infections (Paddock, 2007).

The skilled nursing facility will not be reimbursed for the cost of care and services for that time.

The additional time in the SNF, 13 days, will be covered by Medicare Part A except for the $148

daily co-pay (2013 Medicare Costs, 2012) . A2. Medicare Part B

Medicare Part B covers services such as physician and other healthcare providers’ services and

laboratory services and supplies such as walkers if they are considered to be medically necessary

in the treatment of a condition or disease (What does Medicare Part B cover?, 2012). Medicare

Part B is considered medical