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 tending 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 vocalism 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 entryway 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(prenominal) 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 treat facility will be covered 100%. Because her urinary tract infection was hospital acquire d, Medicare will non reimburse the facility for any handling 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 receives 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. ReferencesCherry, B., & Jacob, S. R. (2011). Contemporary Nursing Issues, Trends, and Management (5th ed.). VitalSource Bookshelf. Retrieved from http//www.pageburstls.elsevier.comfederal official 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.htmlFrontline (T.R. Reid). (2008, April 15). Sick Around the World Television broadcast. Germany A popular, largely market-based system. Public air Service.Torrey, T. (2011, November 27). Theres More To It Than Just Patient Safety. About.com Guide. Retrieved from http//patients.about.comUnited States Government. (n.d.). Medicare Benefits (Policy Brief). Retrieved from Medicare.gov www.medicare.gov