The Medicare Part A payment system for acute care is referred to as the Inpatient Prospective Payment System (IPPS) 1. The IPPS covers patients for 90 days of care per episode of illness, with a 60-day lifetime reserve 2. Episodes begin once the patient is admitted and ends after they have been out of the hospital for 60 days straight 2. During the first 60 days of hospital stay, patients are responsible for a deductible of $1,216 2 while Medicare covers the rest. After day 60, patients must begin copayments, starting at $304, through day 90. After 150 days od care patients are responsible for 100% of costs 2. Comparatively, under the Home Health Prospective payment system (HH PPS), patients are not required to make any copayments for the services provided 4. Home Health care is covered for beneficiaries restr...
... middle of paper ...
...l therapists need to go to greater lengths in order to justify that the treatments they are implementing are appropriate for the patient instead of overutilization of resources. In fact, the HH PPS included a lengthy requirement on therapy coverage criteria to insure that therapy services provided in the home are appropriate 7. As a result, therapists deal with increased documentation demands under time restraints.
Despite the differences between the IPPS and HH PPS, both systems share the same goal of limiting overutilization of services and ultimately delivering appropriate and quality care to the patients. Medicare continues to focus on improving the quality of patient care. Through the implementation of the Prospective Payment System, Medicare has attempted to create incentive for healthcare providers to not only share but also practice this very same mission.
Need Writing Help?
Get feedback on grammar, clarity, concision and logic instantly.Check your paper »
- Due to the sheer volume of billing received each month, it is impossible for the system to review all the information before payment has been released to providers. This has led to a reactive approach in dealing with fraudulent transactions. Medicare database systems are not discovering fraud until after the fact and thus recovering funds can be challenging. As a result, over the last two decades, several legislations have been enacted to assist the Office of Inspector General (OIG) to investigate and prosecute offenders that have committed fraudulent billings against the taxpayer funded insurance system.... [tags: medicare database systems, billing, payment]
633 words (1.8 pages)
- Evolution of Laws Medicare and Medicaid are two health care programs funded by the federal government to provide long-term care to Americans. While the two programs have similar origins, they serve different roles in improving access to care, quality of care, and reducing the cost of care. Medicare functions at the federal level; on the contrary, Medicaid functions at the federal and state level. Since their creation, the two medical programs have undergone different changes to improve access to health care.... [tags: Health care, Medicare, Health insurance]
1222 words (3.5 pages)
- Medicare is a social policy many of our seniors look to for their stability when they reach 65 years of age. Prior to Medicare, barely half of the population age 65 and older had health insurance and of those who did, the coverage was repeatedly narrow. Individuals whose health had worsened could have their coverage stopped or premiums increased (Aaron & Lambrew, 2008). Started in 1965 as a portion of the Social Security Act, Medicare’s chief objective is to offer economic protection against the amount paid by persons 65 and over for hospital and physician treatment.... [tags: medicare, health insurance, health policy]
1965 words (5.6 pages)
- The IPPS or the inpatient prospective payment system refers to a system of payment which includes the diagnosis-related groups’ cases as acute care hospital inpatients. This system is based on resources which are utilized when treating Medicare recipients belonging to these groups. Each diagnosis-related group (DRG) comprise of a payment weight. The IPPS serves an integral role when it comes to deciding the overall hospital costs of all the devices used to treat the patient in within a specific inpatient stay.... [tags: healthcare, ambulatory services]
969 words (2.8 pages)
- Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare. What is Medicaid?” 2008).... [tags: Health Care]
1303 words (3.7 pages)
- Introduction Nearly every aspect of the United States health care system is complex; Medicare is no exception. Discovering who is eligible for Medicare, how Medicare is paid for and what benefits are covered under which part is confusing at best. Medicare has four parts: Part A, Part B, Part C and Part D. Not all of these require premium payments and different services are covered under each part. Furthermore, the financing of Medicare is difficult to understand because it is funded by several different sources.... [tags: enrollment, age, policy]
1873 words (5.4 pages)
- 1. The two major differences between Medicare and Medicaid are who the plan is provided for and who is in charge of providing each plan. The majority of other differences stem from these two dissimilarities. Medicare is a health insurance plan for people over 65 years of age (also includes a few other smaller groups such as younger children with certain disabilities), while Medicaid is provided for citizens who cannot afford other healthcare insurance plans due to their low income. Because of this, Medicaid pays the providers less, so it is not uncommon that doctors will refuse to take patients who use Medicaid.... [tags: Medicine, Physician, Health care]
1179 words (3.4 pages)
- ACA Medicaid reform: Five reforms The implementation of ACA sought to reform the current challenges. There are currently six options of reform a state can implement according to the ACA. Each option allows the states to expand opportunities, research, delivery and quality of care. To date nearly every state has adopted at least one provision introduced by ACA. Jackson (2012) states, the ACA required states to expand their Medicaid programs to all individuals under age 65 with incomes below 133 percent of the federal poverty level, or lose all federal Medicaid dollars.... [tags: Health care, Managed care, Health insurance]
957 words (2.7 pages)
- Medicare Advantage Program/ Medicare+Choice: Part C The Balanced Budget Act of 1997 created Part C to allow individuals to choose private plans as alternatives to Parts A and B. Private plans must include at least all services offered in Parts A and B, and may include reduced cost sharing or premiums. Part C is paid for by the HI trust fund and the Part B SMI trust fund, and is proportional to the amount of benefits paid by Parts A and B. Administrative costs for Part C totaled 1.4% in 2008. Beneficiary payments vary by plan, and are based on capitation; beneficiaries pay a fixed monthly amount regardless of the actual services used (Klees et al., 2009).... [tags: private plans, insurance fraud]
946 words (2.7 pages)
- A.1 Standards Medicare is health insurance coverage provided by the Federal Government. In order to qualify for Medicare, you must meet certain conditions. A person qualifies if they are 65 years of age and older, a person may qualify if they are under the age of 65 with disabilities or have end stage renal disease that requires dialysis or needing a kidney transplant. Medicare does not cover the cost of all healthcare. (Social Security Administration, 2016, p. 4) Medicare has four parts A, B, C, and D.... [tags: Health care, Medicare, Health insurance, Hospital]
872 words (2.5 pages)