The Problems of the Uninsured Essay -- Health Care

Scenario 1 Part A I would clarify the daughters’ confusion regarding Medicare versus Medicaid. Medicaid is a federal health insurance program which provides assistance to uninsured individuals who meet certain criteria. Medicare is a federal health program for persons over the age of 65 who qualify for social security benefits and certain disabilities (Cherry & Jacob, 2011). Mrs. Zwick qualifies for Medicare part A because she is over the age of 65, and most likely worked which makes her eligible for social security benefits. Her Medicare Part A plan will cover her hospital admission in full. Part A-Hospital Insurance will cover Mrs. Zwick for her five day hospital stay and continue to do so up to 55 more days after the first $1,068 (United States Government, n.d.). Because she met the criteria of a hospital stay of at least three days, her first 20 days at the skilled nursing facility will be covered 100%. Because her urinary tract infection was hospital acquired, Medicare will not reimburse the facility for any treatment or extended stay. Medicare considers a urinary catheter acquired infection a never event. This means that it should never have happened, or could have been prevented and therefore Medicare will not reimburse the facility (Torrey, 2011). Neither the daughter nor patient knows this was a hospital acquired infection and I would strongly suggest the health care provider to be forthright and tell the family. Medical Coding of conditions for the insurance company is how the hospital recei ves appropriate reimbursement, and a treatment that improperly coded could lead to fraud. Medicare states that a patient cannot be billed for any additional care needed to resolve a never event (Torrey, 2011). Medi... ...nses except for small copayments. References Cherry, B., & Jacob, S. R. (2011). Contemporary Nursing Issues, Trends, and Management (5th ed.). [VitalSource Bookshelf]. Retrieved from http://www.pageburstls.elsevier.com Federal Government. (n.d.). FAQs For Employees About COBRA Continuation Health Coverage (Fact Sheet). Retrieved from FAQs For Employees About COBRA Continuation Health Coverage website: www.dol.gov/ebsa/faqs/faq-consumer-cobra.html Frontline (T.R. Reid). (2008, April 15). Sick Around the World [Television broadcast]. Germany: A popular, largely market-based system. Public Broadcasting Service. Torrey, T. (2011, November 27). There’s More To It Than Just Patient Safety. About.com Guide. Retrieved from http://patients.about.com United States Government. (n.d.). Medicare Benefits (Policy Brief). Retrieved from Medicare.gov: www.medicare.gov