Healthcare Organization and Finance Research Paper

Download this Research Paper in word format (.doc)

Note: Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from Research Paper:

Healthcare Organization and Finance


Medicare covers healthcare services such as surgeries, laboratory testing and doctor visits. It also covers supplies such as walkers and wheelchairs. These services and supplies must be considered as indispensable in the treatment of a certain disease or condition (King, 2009). Therefore, the expenses related to the walker that was prescribed to Mrs. Zwick after her discharge would be fully met in this section of the Medicare.

Essentially, part A of Medicare covers a host of services, which include hospital care, skilled nursing facility care, hospice, nursing home care, and home health care services. Concerning Mrs. Zwick case, Part A of Medicare will meet the cost for the 5 days she received at the hospital as well as the 21-day care she received under the care of skilled nursing home. However, it is worth noting that copay applies to most of these services.

Part B of the Medicare covers two types of services. These are the medically necessary services and the preventive services. Medically necessary services are the services or supplies that are required to diagnose or treat a medical condition and that adhere to acceptable set of standards of medical practice. For instance, the IV antibiotics given to Mrs. Zwinc after suffering the urinary infection will be partly covered under this plan. On the other hand, preventive services cover health care services that serve to prevent an illness (such as flu) or detect it well in advance when the treatment can be effective. In general, part B of the Medicare is used to cover things such as clinical research, durable medical equipment, ambulance services, mental health (for inpatient, outpatient, and partial hospitalization), getting a second opinion before taking up a surgery, and limited outpatient prescription drugs (Wakefield, 2008).

Part D of the Medicare relates to Medicare prescription and drug benefit. Its main purpose is to subsidize the costs of prescription drugs for the beneficiaries of Medicare. Under this plan, part of the cost of the drugs prescribed at her discharge will be met by the Medicare. All she needs to do is to inquire from her prescriber if at all she can apply for exceptions from some of the prescribed drugs. Depending on the tier of the drug, either low or high, the prescriber will recommend to Medicare provider on the cost to be covered.

B. Medicare Policy and Reimbursement

The United States Centers for Medicare and Medicaid Services (CMS) prohibits medical facilities from billing beneficiaries of the program for the difference between the lower and higher payment rates. Instead, the hospitals are being encouraged to combat an adverse event as well as improve the quality of care that Medicare beneficiaries receive (Daly, 2010).

CMS identified catheter- associated urinary tract infections as one of the condition that require reimbursement. Under the policy, hospital acquired conditions will be identified basing on the administrative billing data. In order to assist in the process, hospitals are required to incorporate a POA indicator for secondary diagnoses. Use of codes is expected to increase the reliability and validity of the method used in identification of the hospital-acquired infection (Daly, 2010).

1. Ethical implications

Code of ethics for in medical professions stipulates that patients have a right to quality medical care free from any form of exploitation. This implies that the doctors and nurses are required to offer the patient with the necessary information regarding their condition and the billing procedures. An ethical issue arises in the situation of Mrs. Zwick's when she acquires a urinary infection while acquiring care from the medical facility. It is evidently clear that this information is kept away from her. As such, she has to incur the extra cost related to the six antibiotics she received as part of her medication (Harrison & McDonald, 2008).

It is ethically incorrect for the medics to conceal the vital information from her. Besides, in the event the hospital applies for reimbursement, it would have unfairly charged Mrs. Zwick. Therefore, as the CMC policies stipulate, it is the role of all medical institution under Medicare program to provide genuine information for reimbursement (Wakefield, 2008).

Scenario 2

C. Explain how the Consolidated Omnibus Budget Reconciliation Act (COBRA) will allow Mr. Davis to continue his insurance coverage while he is out of work.

Under normal condition, COBRA insurance would cover Mr. Davis for a maximum period of…[continue]

Cite This Research Paper:

"Healthcare Organization And Finance" (2013, January 27) Retrieved October 22, 2016, from

"Healthcare Organization And Finance" 27 January 2013. Web.22 October. 2016. <>

"Healthcare Organization And Finance", 27 January 2013, Accessed.22 October. 2016,

Other Documents Pertaining To This Topic

  • Healthcare Organization

    Health Care Organization- Memorial Regional Hospital Florida | Health care organization-memorial regional hospital Florida memorial Regional Hospital Florida was established in the year 1953 and since then for about more than five decades it has been associated with the community health care programs and committed to serve wide range of population in the region. Memorial regional Hospital has enjoyed the stature of being one of the largest hospitals in Florida. It has

  • Healthcare Organizations Hcos Healthcare Organizations Whether...

    Healthcare Organizations (HCOs) Healthcare organizations -- whether they be for-profit or nonprofit -- are a vital component of American society, and as such need to be performing their duties and living up to their missions in order to provide the best healthcare services to the public that is possible. This essay covers many of the issues and points that are important to of any healthcare organization. What are the advantages and disadvantages

  • Health Care Organization Over the

    Outline some considerations that an organization must address when negotiating a risk contract. Some considerations that must be taken into account during any part of the negotiation process include: the overall impact that this will have on revenues, possible effects that this can have on the business model, the downside of entering these kinds of agreements and the overall benefits that can be realized for both organizations. These different elements are

  • Health Care Finance

    Health Care Finance Assets and Liabilities Assets and liabilities are found in a balance sheet. Baker and Baker (2011, p. 107) define a balance sheet as a record of "what an organization owns, what it owes, and basically, what it is worth." Item Asset Liability Cash Inventory Bonds payable Buildings Payroll taxes due Accounts payable Equipment Notes receivable Assets, in basic terms, are all those items that an entity owns. In essence, an asset should have some value attributable to it. Current assets, according

  • Fictional Hospital Create Imaginary Health Care Organization

    Fictional Hospital Create imaginary health care organization (hospital). Evaluate organization basis Baldrige National Quality Program Health Care Criteria Performance Excellence listed. (1) Leadership: (a) Describe senior leaders' actions guide sustain organization. Healthcare organization: XYZ Hospital Leadership The senior leaders of XYX Hospital are notable for the breadth and depth of their experience in the field of healthcare. All senior leaders have experience in the field as practitioners or as former leaders of public healthcare

  • Legacy Emanuel A Healthcare Organization Audit Summary

    Legacy Emanuel: A healthcare organization audit summary Legacy Emanuel Medical Center, at 2801 North Gantenbein Avenue, Portland, Oregon is is an IRS 501 (c ) 3 not-for-profit, tax-exempt corporation comprised of five full-service hospitals and a children's hospital. The Center's award-winning facilities offer an integrated network of health care services: acute and critical care, inpatient and outpatient treatment, community health education and a variety of specialty services. The area's largest locally owned, nonprofit health

  • Financial Planning in Health Care Organizations 1

    Financial Planning in Health Care Organizations [1: Please note that all sources and facts utilized in this paper are from the customer provided reading material.] Healthcare is on everybody's mind today. From the insurance debate in Congress to our own personal worries about dental or medical insurance and how we can obtain it at a low price, healthcare is not only widely discussed in our society, but it is necessary to

Read Full Research Paper
Copyright 2016 . All Rights Reserved