Good Morning, The Training department is ready to roll out Medicare Advantage training today. We have selected Edwards, Cory , Solache, Melissa, Smith, Adrianna, Hurtado, Delilah , Stooksbury, Jackie and Correa, Mirian for the core support team. We are requesting for assistance with the best time frame to start our training, we will have one on one training with each representative for 30-45mins. Training will send out invites to each representative for training times and CC: supervisors and Tammy to ensure communication.
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
The Joint Commission is a nonprofit organization that focuses on improving the Healthcare system. They do this by regulating and evaluating health care organizations, helping them improve and give a more effective and safe care (The Joint Commission, 2012). The National Patient safety goals are ways in which the joint commission strives to improve the way health care is provided (The Joint Commission, 2012). Effective on January 1, 2012, the Joint commission came up with new ways to improve the Care of Medicare Based Long term Care facilities and provided Safety regulations to be followed. In order to better understand the impact that this regulations have in the healthcare, it is necessary to identify and describe the purpose of each regulation, and emphasize on the impact that falls in particular, can have among the geriatric patients.
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed
The United States of America accounts for only 5% of the world’s population, yet as a nation, we devour over 50% of the world’s pharmaceutical medication and around 80% of the world’s prescription narcotics (American Addict). The increasing demand for prescription medication in America has evoked a national health crisis in which the government and big business benefit at the expense of the American public.
On December 8, 2003, President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108-173). This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit, more choices, and better benefits under Medicare. It produced the largest overhaul of Medicare in the public health program's 38-year history. The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin. One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration during Congressional debate. The inaccurate figure helped secure support from fiscally conservative Republicans. It was reported that an administration official, Thomas A. Scully, had concealed the higher estimate and threatened to fire Medicare Chief Actuary Richard Foster if he revealed it. By early 2005, the White House Budget had increased the 10-year estimate to $1.2 trillion.
Canada is at a crossroads today. The number of older Canadians is increasing dramatically as the baby boomers age. All across the country, waiting lists keep growing and many patients cannot find a family doctor. Governments have huge deficits and hard pressed for additional funds. Critics argue that urgent action is needed and that by encouraging people to pay will lessen wait times. However, in reality Canadians would be worse off if they had to pay for some of their medical care themselves.
According to Center for Medicare and Medicaid Services (CMS), around 3500 optometrists have attested for Electronic Health Records (EHR) incentives. In the coming years the incentives will decline and penalty be put on those practitioners who fail to attest to Meaningful Use for EHRs. The biggest question in everyone’s mind is that are you ready for Meaningful Use Stage 2 requirements in 2014?
Medicare was designed as a universal healthcare program for individuals 65 years old and older. This program is funded by Medicare taxes and general federal funding withholding taxes. Medicare is a partnership between federal and state with the goal to provide medical insurance to the elderly that is poor and disabled. Generally all people who are 65 years or older and qualify for social security will automatically qualify for Medicare.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.
Our current health care system is already overwhelmed by the influx of older patients. If we do not take action now to remedy this shortage, we will jeopardize the future of our aging society’s health. Elder Workforce Alliance urges action for federally mandated requirements of geriatric training in all health professions, positive working conditions for healthcare providers devoted to elder care and redesigns of healthcare delivery models to achieve higher quality of care for geriatric patients.
Medicare is a health care system that has been around since 1965 and currently covers over 49 million people. Medicare is a major milestone in the history of American health care. However the people that medicare covers have a wide range of opinions about it. I interviewed D.S. she is a 75 year old woman from Saint Louis. She has experienced Medicare in several different ways which will be discussed throughout this interview.
To combat these and other issues that can arise due to a lack of training, the development of a training program will wan...
Stein, J. A., & Chiplin, A. J. (2014). 2014 Medicare handbook. New York: Wolters Kluwer Publishers.
the greater understanding of importance of multifaceted approach to addressing healthcare issues but also strengthened my critical thinking skills in design and evaluation of effective plans. Similarly, I am participating in the six-day proposal development training program in the upcoming month and the training will certainly help me to acquire further knowledge in health care planning and