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Medicare and Healthcare Administration CFOS

Words: 605 Length: 2 Pages Document Type: Essay Paper #: 46187201

With four out of every ten hospital stays covered by Medicare, and almost half of hospitals’ overall revenue, Medicare cost strategies are critical for healthcare financial management (Herman, 2012). In “7 Strategies to Help Hospitals Break Even on Medicare,” Herman (2012) discusses ways hospital administrators can better manage their Medicare strategy. Hospitals do not break even on Medicare unless they implement proactive strategies for addressing potential shortfalls. Short of advocating for political reform of Medicare policies and programs, Herman (2012) claims that hospital CFOs can actually develop methods of financial management that minimize losses and ensure solvency. Herman (2012) offers seven suggestions to hospital administrators and CFOs, the most important of which is forming strategic alliances and partnerships.
Strategic partnerships are important to hospitals not just for Medicare cost structuring but for overall cost-effectiveness. Pooling resources allows all partners to benefit from their relationships, while also improving the quality of…… [Read More]


Herman, B. (2012). 7 Strategies to Help Hospitals Break Even on Medicare.
Kivlahan, C., Orlowski, J. M., Pearce, J., Walradt, J., Baker, M. & Kirch, D. (2016). Taking Risk: Early Results From Teaching Hospitals’ Participation in the Center for Medicare and Medicaid Innovation Bundled Payments for Care Improvement Initiative. Academic Medicine 91(7): 936-942.
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Medicare Diabetes Prevention Act of

Words: 1429 Length: 4 Pages Document Type: Term Paper Paper #: 26075126

The CDC has provided almost $7 million in funding to establish DPPs for research purposes, which means the number of pre-diabetes individuals helped by these programs will be very limited (CDC, 2012). While these programs will probably provide free or nearly-free diabetes preventive services to a large number of individuals, most underserved patients will not benefit from these programs.

S. 452 is worded in such a way that establishing DPPs under Medicaid will be optional for states (Sebelius, 2010). As of 2010, 43 states covered the expense of screening Medicaid patients for diabetes, but only 13 states provided reimbursement for obesity preventive services. This suggests that states are willing to pay for screening, but not preventive services like lifestyle interventions; however, if only a few states implement DPPs for Medicaid recipients, this will provide a proof-of-principle experiment in a real-world setting and establish the overall healthcare savings such programs can…… [Read More]


CDC (Centers for Disease Control and Prevention). (2012). National Diabetes Prevention Program. Funded Organizations. Retrieved 17 Apr. 2013 from .

Civic Impulse, LLC. (2013). S. 452: Medicare Diabetes Prevention Act of 2013. GovTrack.U.S.. Retrieved 17 Apr. 2013 from .

DPPRG (Diabetes Prevention Program Research Group). (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care, 26, 36-47.

Green, Lawrence W., Brancati, Frederick L., Albright, Ann, and PPDWG (Primary Prevention of Diabetes Working Group). (2012). Primary prevention of type 2 diabetes: Integrative public health and primary care opportunities, challenges and strategies. Family Practice, 29, i13-i23.
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Medicare Access Reauthorization Act or MACRA

Words: 1411 Length: 5 Pages Document Type: Essay Paper #: 92712736

On April 16, 2015 an Act called the Medicare Access and CHIP Reauthorization Act (MACRA) was passed, which is a piece of history of bipartisan legislation. Eventually, on October 14, 2016 the Centers for Medicare & Medicaid Services, the department of Health and Human Services, and the regulatory agency which takes care implementing and putting into practice MACRA, gave out an ultimate rule with a comment duration putting into practice the provisions of MACRA. MACRA revokes the highly denounced Sustainable Growth Rate Formula together with its schedule for Medicare Physician Fee (MPF) cuts, substituting it with the Quality Payment Program, which is a new model that focuses on cost measurement and quality, as well as payment and reporting adjustments. Physicians and their assistants, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetics are all part of the eligible clinicians indicated in Medicare Part B and their QPP includes the…… [Read More]

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Financial Impact of Medicaid

Words: 1886 Length: 7 Pages Document Type: Essay Paper #: 21349879

Medicaid Budget Analysis

The author of this report has been charged with doing a budgetary analysis of the federal program that is known is Medicaid. While its counterpart Medicare focuses on helping those that have reached retirement age, Medicaid is geared more towards those people of any age that are encountering poverty and/or that have encountered a recent disaster like a hurricane or an earthquake. This report will answer several questions about Medicaid including the general budgetary policies that Medicaid follows, the legislative committee(s) that are assigned to the task, how the budgetary changes affect the community, whether a deficit/cut situation is better or whether surplus/additional funding should be done instead, the political climate in the home state of the author of this report, how the people in that home state drive the agenda and how this all differs from developing legislation overall. At least five references will be cited…… [Read More]


270 To Win. (2015). Iowa Presidential Election Voting History. Retrieved 3 October 2015, from 

Ballotpedia. (2015). Government budgets - Ballotpedia. Retrieved 3 October 2015, from 

Kaiser. (2015). Medicaid and Its Role in State/Federal Budgets & HealthA Reform. Retrieved 3 October 2015, from 

Levey, N. (2015). Head of federal agency overseeing Medicare and Medicaid steps down. Retrieved 3 October 2015, from
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Medicaid and HMO's

Words: 2428 Length: 9 Pages Document Type: Term Paper Paper #: 97026135

Medicaid has long been an issue of debate throughout the country. Healthcare is a critical need and many Americans do not have any healthcare. Therefore, Medicaid is vitally important because it provides healthcare to the poor. For many years, both federal and state governments have attempted to reduce the cost associated with Medicare. Some states have resorted to allowing HMO's to take responsibility for some of the recipients of Medicaid. This is particularly true is Georgia with the passage of House Bill 392. According to Goggin (2002) "the shift to managed care has been evident in both the private and public sectors ... Today, over 85% receive health care through some type of "managed delivery." Similarly, growth in managed care coverage of Medicaid clients has grown from 14% in 1993 to 56% in 2000 (Goggin 2002)."

For the purposes of this discussion we will focus on the implications of this…… [Read More]


Baily, M.A. (2003). Managed Care Organizations and the Rationing Problem. The Hastings Center Report, 33(1), 34+..

Georgia Medicaid Managed Care RFP Review

Medical Association of Georgia. 2005.

House Bill 392 (AS PASSED HOUSE AND SENATE). 2005. 33 0691/AP
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Medicaid Health Care Assistance How Does the

Words: 1084 Length: 4 Pages Document Type: Essay Paper #: 69946352

Medicaid Health Care Assistance

How does the organization fund its programs?

Medicaid was developed for the sole purpose of providing health care services to low income individuals and families. For those people that cannot afford to pay for these services, the program makes it possible for you to get the treatment you need when obtaining them is challenging (based upon financial considerations). To qualify for this entitlement program there are a number of different factors that will be taken into account to include: the age of a person, nationality, disability (if any), income and property owned. ("Overview," 2011)

The program is funded by the states / federal governments and it is managed by each state individually. The federal government pays an average of 57% of Medicaid's expenses. While the state, designs their own program within specific federal requirements. In general, state participation in the program is voluntary. The way that…… [Read More]


Overview. (2011), CMS. Retrieved from: 

Luhbi, T. (2011). Shrinking Medicaid Funds. CNN. Retrieved from: 

Robertson, G. (2010). NC Medicaid Fraud. Business Week. Retrieved from: 

Villareal, P. (2006). Federal Medicaid Funding. NCPA. Retrieved from:
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Medicaid Changes US Health Policy

Words: 664 Length: 2 Pages Document Type: Research Paper Paper #: 96885303

There will no longer be automatic re-enrollment for recipients. The plan seeks to cut the cost of Medicaid by moving at least half of the recipients out of the program (Medicaid changes on the horizon in Illinois, 2011, Quad City Times).

Even President Obama recently proposed cost cuts to the federal Medicaid program, in light of the pressure to reduce government expenditures. Obama has proposed replacing the federal Medicaid matching formula with a single rate and also to reward states for efficiency and enrollment reduction (Luhby 2011). (The set limits will increase if the unemployment rate increases and the U.S. another recession). The bill would also bolster the controls of the Independent Payment Advisory Board (Luhby 2011).

Still, if the Affordable Care Act's full provisions are put into action, it could prove highly beneficial for a particular problem that afflicts Illinois -- that of reimbursement for physicians who serve Medicaid…… [Read More]


Fletcher, Michael A. (2011, June 9). GOP governors push back against Obama on federal

Medicaid rules. The Washington Post. Retrieved June 17, 2011 

Luhby, Tami. (2011, April 13). Obama lays out plans for cutting Medicare, Medicaid. CNN.
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Access to Care Medicare Is

Words: 1286 Length: 5 Pages Document Type: Term Paper Paper #: 3905923

Further, in order to be covered by Medicare, the stay at the nursing home must include care that requires skilled nursing. In other words, Medicare will not cover custodial, non-skilled or long-term care that includes activities of daily living, such as cooking, cleaning and hygiene. A stay at a skilled nursing facility under Medicare is limited to one-hundred days per ailment. Medicare will pay for the first twenty days in full. The remaining eighty days requires the patient to pay a co-payment of approximately $124.00 per day.

Under Medicare Part , Medicare will provide medical insurance to a qualified individual. This coverage includes physician and nursing services, x-rays, laboratory and diagnostic testing, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital treatment, some ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments and other outpatient medical care treatments as administered in a physician's office. However, medication administration…… [Read More]


Marrelli, Tina M. (2001): Handbook of Home Health Standards and Documentation Guidelines for Reimbursement. Elsevier Health Sciences.

Matthews, Joseph L., Dorothy Matthews Berman. (2007): Social Security, Medicare and Government Pensions: Get the Most out of Your Retirement and Medical Benefits. New York: NOLO.

Vogel, Ronald J. (1999): Medicare. Anne Arbor: University of Michigan Press.
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Understanding how Medicaid'services have improved healthcare

Words: 4133 Length: 4 Pages Document Type: Term Paper Paper #: 64629307

educe Medicaid Program Costs and Enhance Utilization and the Quality of Care Through Medicaid Managed Care

Medicaid is a type of health insurance provided and funded by the federal government and states to provide coverage to all Americans who are eligible low-income adults, children, elderly adults, pregnant women, and individuals with disabilities. Managed Care is a health care delivery system that was organized to manage cost and quality. The use of managed care in Medicaid is to deliver Medicaid health benefits and additional services through contracted arrangements that are between state Medicaid agencies and managed care organizations. By contracting with different types of managed care organizations, states can reduce Medicaid program costs and better manage the use of health services as well as enhance health care quality (

Medicaid Managed Care is a federal government sponsored medical care system designed to deliver quality care and to reduce cost of health…… [Read More]


Ae-Sook, K., & Jennings, E. (2012). The evolution of an innovation: Variations in Medicaid managed care program extensiveness. Journal of Health Politics, Policy & Law, 37(5), 815-849. doi:10.1215/03616878-1672727

Bisgaier, J., & Rhodes, K. (2011). Auditing Access to Specialty Care for Children with Public Insurance. The New England Journal of Medicine, 364(24).

Center on Budget and Policy Priorities, (2013). Policy basics: Introduction to Medicaid. Retrieved from 

Charlson, M.E., Wells, M.T., Balavenkatesh, K., Dunn, V., & Michelen, W. (2014). Medicaid. managed care: How to target efforts to reduce costs. BMC Health Services Research, 14(1), 16-31. doi:10.1186/1472-6963-14-46
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Prescription Drugs Number of Medicare

Words: 1531 Length: 5 Pages Document Type: Term Paper Paper #: 92313347

The Act creates a positive balance between government interests to save money and the interests of Medicare recipients to receive a wide range of drugs for their specific needs. The current ban on government negotiations with pharmaceutical companies serves to protect Medicate recipients by using the positives of the free market, such as the experience and purchasing power of PBMs. hile there are serious potential problems with this approach, such as the potential for fraud between pharmaceutical companies and private interests, overall the ban on government negotiations with pharmaceutical companies provides a good balance between recipient and government interests.

orks Cited

American Legislative Exchange Council. Prescription Drugs. 19 October 2005.

Barry, Patricia. New Salvos in the Prescription Drug ars: Class action suits are exposing schemes that gouge consumers. AARP Bulletin, January 2005.

19 October 2005.

Dealey, Sam. Drug Dealings: Democrats had it right before. National Review Online, May…… [Read More]

Works Cited

American Legislative Exchange Council. Prescription Drugs. 19 October 2005. 

Barry, Patricia. New Salvos in the Prescription Drug Wars: Class action suits are exposing schemes that gouge consumers. AARP Bulletin, January 2005.

19 October 2005. 

Dealey, Sam. Drug Dealings: Democrats had it right before. National Review Online, May 05, 2004, 9:12 A.M. 19 October 2005.
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Guide to Medicare Ethics

Words: 692 Length: 2 Pages Document Type: Essay Paper #: 35990847

Healthcare Law -- Ethics & Policy

Memo to ABC Hospital Board of Directors: How to develop strategies to help mitigate abuse and fraud within our organization by understanding fraud and abuse issues.

The Department of Health and Human Services has provided a great deal of good information for healthcare professionals and the public in terms of ways to avoid and/or deal with fraud and abuse. This document reflects the ways in which this hospital can be on the lookout for fraud and abuse when it comes to Medicare. This document will also explain the difference between fraud and abuse in the Medicare system.

Medicare Fraud

Typically Medicare fraud means a person in this hospital -- or a doctor affiliated with this hospital contractually -- would knowingly submit false statements or somehow misrepresent what his or her services actually were, in an attempt to cheat the federal government. Also a healthcare…… [Read More]

Works Cited

Department of Health and Human Services / Centers for Medicare & Medicaid Services.

Medicare Fraud & Abuse. Retrieved March 1, 2015, from .
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Recent Trends in Medicare Reimbursements

Words: 795 Length: 2 Pages Document Type: Essay Paper #: 51902644

Professional health care providers in direct contact with patients have been required to be licensed and credentialed demonstrating current competencies of quality and safe healthcare practice. Should similar licensing and credentialing requirements be imposed on collaborative workers in the health care industry who may not be directly serving patients (e.g., business office personnel, CEOs, CFOs, or other administrators)? Why or why not?

Collaborative health care workers should not be generally required to obtain similar licensing and credentials as their direct-patient care provider counterparts for two main reasons: redundancy and excessive costs First, requiring collaborative health care workers to obtain licensing and credentialing similar to direct patient care providers would be redundant because some collaborative health care industry executives who perform administrative tasks that do not involve direct patient care already possess professional licensing and credentials by virtue of their current occupational status and previous work experience (e.g., physicians or advanced…… [Read More]

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Eligibility Rules and Agency Program Policy the Medicaid

Words: 895 Length: 3 Pages Document Type: Essay Paper #: 69525794

Eligibility ules and Agency/Program Policy

The Medicaid Program

Medicaid is a federal assistance program that is administrated at the federal level by the Centers for Medicare and Medicaid Services (CMS) and at the state level by the corresponding state agencies of the individual states. It is a program designed to assist needy individuals with medical expenses. Medicaid eligibility is quite strict and is an example of eligibility by rule and regulation as well as by means testing (Chambers & Wedel, 2005).

The program provides coverage for all of the following healthcare services for program beneficiaries: Inpatient hospital services, Outpatient hospital services, Laboratory and X-ray services including radiation therapy, Physician's services, Podiatric services, Naturopathic services, Vision care, Family planning services, Home health services, Certain chiropractic services, Health clinic services, Early Periodic Screening, Diagnosis and Treatment (EPSDT), Dental services, including orthodontia services, Maternity clinic services, Ambulatory surgical center facility services, Emergency hospital…… [Read More]


CMS. (2010). U.S. Department of Health and Human Services -- Centers for Medicare

and Medicaid Services. Overview: Medicaid Eligibility. Retrieved April 11, 2011

from: /MedicaidEligibility/" target="_blank" REL="NOFOLLOW">
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Medicaid Budgetary Policy Analysis

Words: 2173 Length: 7 Pages Document Type: Research Paper Paper #: 58075660

Budgetary Analysis

Process for Budgetary Policies and Assigned Legislative Committees

A government budget can be defined as an official contract or arrangement that specifies the amount of revenue to be raised, where such revenues will be sourced, and the manner in which the revenues will be utilized. In most societies, the budget is in actual fact an assortment of policy contracts that specify the tax laws and also the level of spending for particular programs; thus they are more than just a complete and inclusive document. The process for budgetary policies therefore refers to the guidelines and procedures that are employed by policy makers to frame, ratify, and implement these agreements for revenues and spending (Crain, 2004).

For state governments as well as the federal government in America, the process for creating budgetary policies is comparatively simple to define in a conventional manner. Generally, the first phase of the process…… [Read More]


Black, J. (2009). How to Un-Supplement a Tsunami of Fiscal Proportions: An Examination of the Supplemental Appropriations Process. Georgetown University Law Center.

Cooper, J.C. (2010). Prime Numbers: Deficit Cuts A Priority for Americans. Fiscal Times. Retrieved 30 May 2015 from: 

Crain, W.M. (2004). Budgetary Processes. In The Encyclopedia of Public Choice (pp. 370-373). Springer U.S..

Hall, M.A. (2014). States' Decision Not to Expand Medicaid. North Carolina Law Review. Retrieved 30 May 2015 from:
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Healthcare Medicare Part D Medicare

Words: 688 Length: 2 Pages Document Type: Thesis Paper #: 74576291

Although the Medicare prescription drug program has provided access to medications for seniors at a lower cost to the government than was originally expected and has lowered the out of pocket costs for the consumers, there is talk about needing to overhaul the program. Critics contend that the government should be able to negotiate lower costs for prescription drugs than private insurances can. It is also felt that the entire program is too confusing for the elderly beneficiaries and needs to be made more understandable (Wechsler, 2008). All of these proposed changes come with Medicare still trying to uphold there objectives of providing affordable prescription drugs to seniors.

It is believed that even with these proposed changes taking place there is still a need for greater education about the program as a whole. It is hoped that with increased education that consumers will be more informed about the choices that…… [Read More]


Hsu, John, Fung, Vicki, Price, Mary, Huang, Jie, Brand, Richard, PharmD, Rita Hui,

Fireman, Bruce and Newhouse, Joseph. (2008). Medicare Beneficiaries' Knowledge of Part D Prescription Drug Program Benefits and Responses to Drug Costs. Journal of the American Medical Association, 299(16), 1929-1939. doi: 10.1001/jama.299.16.1929)

Lichtenberg, Frank R. And Sun, Shawn X. (2007). The Impact of Medicare Part D on Prescription Drug Use by the Elderly.

Health Affairs, 26(6), 1735-1744. doi:
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Accountable Care Health Organizations

Words: 763 Length: 2 Pages Document Type: White Paper Paper #: 70558961

Medicaid and the ACA

Discuss the issues central to the expansion of Medicaid created by the Affordable Care Act. From state policy perspective is this a good way to increase access to healthcare at a reasonable cost? Be sure to discuss the success stories you uncover as you complete your research for this question. eview the following and consider the questions below as part of your initial post.

From the State's perspective, expanding Medicaid under the ACA is a sound financial investment. However, the Supreme Court ruled that each state could decide to enter the program individually and as a consequence many states have not. These states claim that they cannot afford the program. However, a report by the Congressional Budget Office clearly shows that the Federal Government will actually be responsible for the bulk of the costs in the first decade of the program -- about 93% of the…… [Read More]


Angeles, J. (2012, July 25). How Health Reform's Medicaid Expansion Will Impact State Budgets. Retrieved from Center on Budget and Policy Priorities: 

Klein, S., McCarthy, D., & Cohen, A. (2014). Health Share of Oregon: A Community Oriented Approach to Accountable Care for Medicaid Beneficiaries. The Commonwealth Fund, 1-12.

Semro, B. (2014, April 29). Numbers Tell the Story of ACA's Success, But They Also Show Millions are Missing Out. Retrieved from The Huffington Post:
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Icd 10 and Its Implementation

Words: 1031 Length: 3 Pages Document Type: Research Paper Paper #: 28953871

Medicare and Medicaid Services (CMS) announced in January that ICD- 10-CM will be implemented into the HIPAA mandated code set on Oct. 1, 2013.

Introduction to the new structure of ICD manual o Statistics

The International Classification of Diseases (ICD) is a program that is designed in order to record statistics of morbidity and mortality and for the indexing of hospital records of disease.

ICD is published by the World Health Organization (WHO).

It has always been statistically difficult to categorize diseases according to any one specific category since different professions that work with diseases have traditionally classified them according to different categories. The pathologist, for instance, is primarily interested in the natural course of the disease process, whilst the anatomist may prefer to have a classification that groups the disease according to the effected part of the body. The statistical classification of disease and injuries depends upon how the…… [Read More]

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502 Correct

Words: 1056 Length: 3 Pages Document Type: Essay Paper #: 93687380

Healt Care Policy

Te government of te United States can influence ealt policy in many ways. Specifically, Congress as te autority to pass laws affecting te ealt care system in te country. Most recently tey debated te new ealt care law tat was passed in 2009. Tis debate was primarily between te Republicans in Congress, wo felt tat easier access to existing private insurance plans was te key to overauling te system, and te Democrats, wo preferred a government run plan to compete wit te private plans (Keefe, 2009).

Te President as te role of ceerleader and adviser, witout a direct role in passing laws. President Obama went on te campaign trail to try to rally people to is side and convince tem tat is plan to cover te uninsured, lower costs, and improve care (Stolberg, 2009). Te President can elp steer te discussion towards te direction e would like…… [Read More] .

Antos, J. (5 Aug 2010). A mistaken prognosis for Medicare. The American. Retrieved from:
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Healthcare Policies

Words: 1952 Length: 5 Pages Document Type: Research Paper Paper #: 86833684

Health Policies Medicare

hen everyone in our country finally starts to reach the age of 65 years of age or older, then every person will become eligible for Medicare. It is clear that there are some elderly that are having minimum health concerns while others recurrently are dealing with medical issues for which they will have to seek out treatment by the doctor. However, research is starting to display that there are at least five top conditions that are enhancing on medical and drug spending. It is obvious that Heart disease circumstances are the number one medical issue that the those that are considered elderly are facing and that is becoming very costly to them. Most are unaware that the second one is the disease cancer and it could be internal or external for various elderly patients. Other issues such as joint ailments a lot of the times can cost…… [Read More]

Work Cited:

Wenzlow, Audra T., et al. "Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners with Serious Mental Illness." Psychiatric Services 62.1 (2011): 73-8.

Sommers, Benjamin D. "Loss of Health Insurance among Non-Elderly Adults in Medicaid." Journal of General Internal Medicine 24.1 (2009): 1-7.

Verdier, James, and Allison Barrett. "How Medicaid Agencies Administer Mental Health Services: Results from a 50-State Survey." Psychiatric Services 59.10 (2008): 1203-6.

Harman, Jeffrey S., Allyson G. Hall, and Jianyi Zhang. "Changes in Health Care use and Costs After a Break in Medicaid Coverage among Persons with Depression." Psychiatric Services 58.1 (2007): 49-54.
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Fraud Specifically Health Insurance Fraud

Words: 7682 Length: 26 Pages Document Type: Term Paper Paper #: 45702393

Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result, it is no revelation that white-collar offenders observe health care deception as a rewarding effort. Certainly, the General Accounting Office ("GAO") quotes that such deception accounts for up to 10% of entire health care expense (3).

As health care deception outlays taxpayers almost $100 billion a year, federal, as well as state agencies have given health care fraud tribunal a key center of attention. All through her term, Attorney General Janet Reno made impeaching health care fraud a top precedence at the Department of Justice ("DOJ"), subsequent only to brutal offenses (3).

The government focuses its pains to perceive, as well as take legal action against health care fraud…… [Read More]


(1) Adelaide Few & Jay Trezevant, Fighting the Battle Against Health Care Fraud & Federal Enforcement Actions, 72 FLA. B.J. 34, 34-6 (1998)

(2) Alice A. Love, Leniency Offered Health Care Providers that Admit Federal Fraud, S.D. Union Trib., Oct. 22, 1998

(3) Andy Bunds, The results of the Health Insurance Regulations on Health Care Fraud and Abuse, 72 Mont L. Rev. 63, 72 (2001)

(4) Brian A. Kaset, Sailing Without Safe Harbors: Physician Recruitment and the Law of Fraud and Abuse, 9 Healths Span. 9, 9 (1992)
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Sociology Discussion Responses Response to Post

Words: 1112 Length: 4 Pages Document Type: Essay Paper #: 15656227

Sociology Discussion Responses

Response to Post #

Your post raises some very important issues that face the entire nation as well as the individual states such as New Mexico. The largest social services programs such as Medicare and Medicaid are unsustainable for the long-term, largely because of the dramatic demographic changes in American society since their development. Today, the average longevity is almost double what it was in the early 20th century when the average life span was only 47 years of age. Likewise, the fact that the post-Word War II Baby-Boom generation is now entering retirement age means that larger than ever numbers of program beneficiaries will have to be supported by fewer working program contributors. Meanwhile, the economy is undergoing a very difficult period and unemployment and underemployment rates, even for college graduates, are at all time lows. Some of the most sensible approaches to solutions might include…… [Read More]

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Future of Healthcare Operations the

Words: 3083 Length: 9 Pages Document Type: Term Paper Paper #: 93994062

Then, when you combine this with the fact that Medicaid serves 53 million people with an annual budget of $329 billion, means that rising costs is severely affecting this program. ("Medicaid Reform," 2005) the inflexibility of this program has contributed to problem as a one size fits all approach is taken. Then, when you combine the different state programs offered through Medicaid, means that an uneven standard of inflexibility is used. An illustration of this can be seen by looking no further than the overall focus of Medicaid, where an emphasis is placed on addressing major health issues. This is problematic because like with Medicare, an approach must be taken of dealing with the patient once they are facing major health issues. Then Medicare has to engage in multiple functions to include: comprehensive acute / primary care, long-term care services (for those who qualify), a source of funding for uncompensated…… [Read More]


Medicaid Reform. (2005, June 15). Retrieved March 3, 2010 from National Governors Association website:

President Cuts Medicare, Medicaid to Help Reform Costs. (2009, June 15). Retrieved March 3, 2010 from California Health Line website: 

Anderson, L. (2009, July 9). Research Project Finds Medicare Part D Increases Spending on Prescription Drugs.
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Management of Continuum of Care Services as

Words: 1121 Length: 3 Pages Document Type: Essay Paper #: 83512191

Management of Continuum of Care Services

As the new director appointed for the Medicare and Medicaid Services (CMS), I realize the climbing costs of payments of these two programs and have met with the other members to come up with a plan of that will help enforce the strategies and guidelines in the state of North Carolina that can help us follow a budget that will assist the overall national requirements for persistent care. In doing so fellow board members have met with me to look at the Medicare Modernization Act (MMA), Administration on Aging (AoA), and other parts of the medical services to help come up with an arrangement that will help us reduce costs in our particular area that will assist the national healthcare problems that we currently face.

After looking at the problems within our own area we have decided to enforce the guidelines of the current…… [Read More]

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Reimbursement Ethics and Compliance Impact of Health

Words: 1349 Length: 4 Pages Document Type: Essay Paper #: 94066832

eimbursement Ethics and Compliance: Impact of Health Care eform on Medical Coding and Billing

"Medical billing and coding lays the foundation for any successful healthcare provider," yet its common practices are undergoing significant changes under the recent proposal for health care reform (Griffey, 2013). The nature of medical coding and billing is increasingly becoming more and more complicated. The recent healthcare reform legislation, passed in 2010, promises to complicate the situation even further. Such reforms will undoubtedly have a huge impact on medical billing and coding processes.

The reform bill was a monumental piece of legislation passed by Pres. Obama and his Democratic supporters in 2010. There are a number of stipulations which aim to help increase access to appropriate health care for millions of Americans who are currently without any coverage, helping lower the cost of premiums too much more affordable rate for most Americans but also increasing the…… [Read More]


Eastaugh, Ben & Sternal-Johnson, Chris (2010). What will health care reform do to medical billing? MD Alliance Billing. Web. 

Griffey, Kimberly. (2013). Medical billing and coding and health care reform: What you need to know. Ultimate Medical Academy. Web. 

Hart, Bradley. (2012). Ethics in Medical Coding: Theory and Practice. McGraw Hill.

Jackson, Jill & Nolen, John. (2010). Health Care Reform Bill summary: A look at what's in the bill. CBS News. Web.
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Mr H Appealing HMO Decision

Words: 714 Length: 2 Pages Document Type: Essay Paper #: 63984167

H's claim with an HMO plan is the need for individuals to remain within the network to receive care. Initially, Mr. H was denied coverage because he did not get a referral from his primary physician to see a specialist. The original treatment to which Mr. H's primary care physician was subjecting Mr. H was 1. not effective and 2. The physician suggested a radical amputation for his condition while the second opinion Mr. H sought suggested a much less radical procedure which would allow Mr. H to retain his mobility. It could be logically argued that had Mr. H not gone 'out of network' he would have suffered substantial medical harm. Furthermore, while the HMO cited as a reason for denial of claim a provision in the plan documents that prevents referrals outside the plan's network when the network's physicians have the capability to perform the required procedure, Mr.…… [Read More]


Appeals of local coverage determinations. (2010). Retrieved October 31, 2010 basics/lcds.asp" target="_blank" REL="NOFOLLOW">
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Strategic Management Process for Implementation

Words: 3248 Length: 12 Pages Document Type: Term Paper Paper #: 2721765


The rationale for the elements stated within the mission, vision and values statement is that through educating and assisting patients in signing up for and choosing their provider under the Medicare Advantage plan that the patients will be enabled to receive the best possible benefits for their individual health maintenance needs.


Strategic goals of this program includes those as follows:

1) Enrollment of all patients in the Medicare Advantage program who are eligible for this coverage.

2) Assisting all Medicare Advantage enrolled patients in utilizing this coverage to the best possible level enabling them to receive the best care possible.


Critical success factors are identified as being those as follows:

Adoption of the necessary technology applications to assist patients;

Efficiency and effectiveness in getting information out of patients concerning the assistance offered by the HMO; and…… [Read More]


Medicare Advantage: How Does it Relate? (nd) Medicare Prescription Drug Coverage. AARP. Online available at 

Hoadley, Jack (2006) Medicare's New Adventure: the Part D Drug Benefit. Commission on a High Performance Health System. The Common wealth Fund Online available at 

Rosenfeld, Sheera; Bernasek, Cathy; and Mendelson, Dan (2005) Medicare's Next Voyage: Encouraging Physicians to Adopt Health Information Technology. Health Affairs 24. No. 5, 2005. Abstract online available at

Medicare Prescription Drug Program (2006) Chapter 5: Covering Health Issues 2006. Online available at
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Healthcare Integrity Is a Major Issue for

Words: 1315 Length: 5 Pages Document Type: Essay Paper #: 2662441


Integrity is a major issue for healthcare organizations because there are many avenues for fraud, and for people to demonstrate a lack of ethics. The problem is that the temptation is sometimes too great and despite the fact that there are laws in place to guard against these practices unethical behavior takes place anyway. The government, which supplies a lot of the money which goes for treatments through Medicare and Medicaid, has structured certain laws to make sure that the practices of healthcare organizations are ethical, but billions of dollars in fines are still doled out every year. The big drug companies complain of arcane and hard to decipher legalese, but the fact is that although they realize the issue and the penalty they continue to subvert the law. This paper looks at qui tam statutes and cases, Medicare and Medicaid admissions criteria, installing a corporate integrity program, and…… [Read More]


American Speech-Language-Hearing Association (ASLHA). (2010). Summary of self- referral and anti-kickback regulations. Retrieved from 

Hanford, J.T. (2001). Regulation of the healthcare professions. Ethics & Medicine, 17(3), 188-190.

Louthian Law Firm. (2012). Healthcare fraud qui tam whistleblower protection lawsuits.

Mattie, A. & Ben-Chitrit, R. (2009) The federal False Claims Act and qui tam actions: What every healthcare manager should know. Journal of Legal, Ethical and Regulatory Issues, 12(2), 49-65.
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Policy Changes in Healthcare Finance Healthcare Finance

Words: 2462 Length: 7 Pages Document Type: Essay Paper #: 81516587

Policy Changes in Healthcare Finance

Healthcare Finance

CPT Codes

The American Medical Association (2013) developed the Current Procedure Terminology (CPT) codes decades ago in the 1960s. The first edition was published in 1966 and over the subsequent years several updated versions were created. The reasons for developing the CPT code system was to make communications about medical procedures easier between health care providers, help patients and their doctors submit claims for services to insurance providers, create a structure that would facilitate the development of an electronics records system, and create categories that would help researchers collect data on the health care field.

The CPT code system expanded with each subsequent edition and with publication of the second edition the codes were transitioned from a 4 to a 5 digit system (American Medical Association, 2013). This transition was necessary as the services covered by the code expanded beyond medicine, radiology, and…… [Read More]


ACRO (American College of Radiation Oncology). (n.d.). Introduction to Relative Value Units and how Medicare reimbursement is calculated. Retrieved 30 Oct. 2013 from

Altman, Stuart H. (2012). The lessons of Medicare's prospective payment system show that the bundled payment program faces challenges. Health Affairs, 9, 1923-1930.

American Medical Association. (2013). CPT process -- how a code becomes a code. Retrieved 30 Oct. 2013 from .

Brinjikji, W., Kallmes, D.F., Lanzino, G., and Gloft, H.J. (2012). Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments. American Journal of Neuroradiology, 33, 1037-1040.
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History of Hospitals Delivery of Inpatient Services

Words: 1191 Length: 3 Pages Document Type: Case Study Paper #: 44676932


Health care in the United States has evolved through governmental and private answers to historical trends, starting with the first days of the United States. Often arising as responses to serious gaps in health care, these remedies traditionally build on each other and have resulted in a uniquely American health care system. The trickle of Baby Boomers into "the elderly" is now posing new challenges for both governmental and private providers, which must be met by new responses and a newly adapted health care system.

Discuss the government's role in responding to historical trends that impact the delivery of hospital care and how this has added to the expansion of hospitals in the United States.

Commencing with the very existence of our Republic, the United States government has taken a leading role in dealing with historical trends, significantly impacting delivery of hospital care and expansion of hospitals in this…… [Read More]

Works Cited

Barton, P.L. (2010). Understanding the U.S. health services system, 4th ed. Chicago, IL: Health Administration Press.

Hays Companies. (n.d.). Inpatient vs. outpatient care. Retrieved April 22, 2012 from Web site:

Setness, P.A. (2002, June 20). The looming crisis in geriatric care: As baby boomeers age, healthcare policy fallout seems inevitable. Retrieved April 22, 2012 from Web sit:

U.S. Department of Health and Human Services. (2012). Timeline of the Affordable Care Act. Retrieved April 22, 2012 from Web site:
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Balanced Budget Act of 1997

Words: 1100 Length: 3 Pages Document Type: Research Paper Paper #: 12670779

Balanced Budget Act of 1997

Introduction with Background

In the last several years, health care costs have been increasingly exponentially. To control the expenses associated with Medicare and Medicaid, the Balance Budget Act of 1997 was enacted. At the heart of its focus, was on reducing the total amounts of fees that are provided to health care providers, doctors and nurses. This is troubling, as these transformations will have an impact on facilities and health care professionals (who may not want to work with these kinds of patients). When this happens, there will be a decrease in choices and the overall quality of services that are provided to these individuals. This is the point that these challenges could adversely impact treatment options that are provided. (Kilgore, 2009)

Evidence of this can be seen in a study that was conducted by Kilgore (2009). She found that the act has changed consumer…… [Read More]


Comparative Analysis. (2012). Business Dictionary. Retrieved from: 

Qualitative Research. (2012), Retrieved from:

Kilgore, M. (2009). The Effects of the Balance Budget Act of 1997. Med Care, 47 (3), 279 -- 285.

Olsen, W. (2012). Qualitative Comparative Analysis. University of Manchester. Retrieved from:
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Challenges in Healthcare

Words: 902 Length: 2 Pages Document Type: Essay Paper #: 46703249

Healthcare Crisis

Health insurance has gone up over the past two years as a result of a nationwide increase .insurance companies have the tendency of settling only a percentage of a patient's bill. The truth of the matter is patients are not the only people who suffer due to this crisis the doctors too fall victims as mots of them opt to close down since they are underpaid by the insurance companies as well as being forced to pay the yearly premiums for malpractice .physicians are taken as the ones who are at fault for the ongoing healthcare crisis. This is true to some extent but they are not the bones to blame entirely as there are many parties involved in this issue. First of all when we look at the money involved we can say that this crisis is the fault of insurance companies since they are out there…… [Read More]


Sharfstein J. Fontanarosa P. & Bauchner H.(2010). Critical Issues in U.S. Health Care

Health Care on the Edge. Retrieved March 14, 2014 from 

Lipthrott, D.(2004). Who is to blame for the healthcare crisis? Retrieved March 14, 2014 from
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Pour Let it Pour General

Words: 1020 Length: 3 Pages Document Type: Term Paper Paper #: 46537174

However, this might turn competent healthcare professionals away, who were angry that they no longer could exercise discretion over their treatment, in conference with their patients. Patients might refuse to come to the hospital. And those that did would cause costs to escalate, as they stayed longer, received more extensive care, and thus exhausted their insurance benefits.

A summary presentation of a comprehensive solution that would cover all of the issues

Firstly, the board of directors should be convened to establish a policy about what the religiously founded hospital considers to be a quality life and an ethical system of evaluating critical patients, when dispensing care. Doctors, nurses, and other involved personnel must be convened to discuss various issues that continually arise and a uniform policy must be established, so that such ethical decisions are not solely the burden of patients and healthcare providers in the field.

A press release…… [Read More]

Works Cited

National Coalition on Health Care. (2004) "Health Insurance Cost." Retrieved 2 June 2005 at 

National Coalition on Health Care. (2004) "Health Insurance Coverage." Retrieved 2 June 2005 at
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PPACA on March 23 2010 the Patient

Words: 1009 Length: 3 Pages Document Type: Essay Paper #: 73826994


On March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. Along with the Health Care Reconciliation Act of 2010, the PPACA became part of the overall Health Care Reform concept of 2010. The health care reform process was promoted as a way to completely transform the health care industry and ensure that all Americans received affordable health care. hile supporters praise the legislation as a revolutionary law which will benefit ordinary Americans, critics claim that the Obama Administration used the health care reform process as a means of gaining control over the entire health care system. In an attempt to compare and contrast the provisions of this new law, this essay will discuss several provisions of the new health care legislation and compare the benefits as well as the criticisms of them.

Section 5501 of the PPACA provides for…… [Read More]

Works Cited

Appleby, Julie. (2011, Jan. 10). Effort To Reward Medicare Advantage Plans Draws Criticism. Kaiser Health News. Retrieved from 

"Side Effects: Obamacare Could Punish Docs for Better Quality Care." (2010, July 16). The Heritage Foundation. Retrieved from

Gold, Jenny. (2011, Jam. 18). "Accountable Care Organizations, Explained." NPR. Retrieved from 

"Health Care Reform: Annual Fee on Prescription Drug Manufacturers and Excise Tax on Medical Devise Manufacturers." (2010, Apr.). Covington & Burling LLP Retrieved from
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Medical Fraud and Abuse --

Words: 635 Length: 2 Pages Document Type: Essay Paper #: 92526914

The facts that you have provided indicate extremely troubling circumstances that could seriously jeopardize the welfare of your organization. It is well-settled law that entities contracting for the services of subsidiaries are legally responsible for legal and ethical improprieties committed by those subsidiaries irrespective of whether or not the contracting organization had any specific involvement in or knowledge of those actions. Accordingly, we would strongly advise that you take immediate action to rectify the situations described in the manner outlined in our recommendations below.


To avoid the potentially serious criminal, civil, and financial consequences arising under MWHC's respondeat superior responsibility to prevent fraud and abuse in connection with its association with subsidiaries, it is hereby recommended that MWHC immediately:

1. Instruct the subsidiary to cease and desist from offering its contracted home health agency employees compensation of any kind in connection with client durable medical equipment (DME) orders from…… [Read More]


Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin Group.

USDHHS. (2004). U.S. Department of Health and Human Services-Office of Inspector

General-Statement of Organization, Functions -- and Delegations of Authority.

Federal Register. Vol. 69, No. 127; July 2, 2004. Retrieved November 14, 2010,
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Medical Care to African-americans The

Words: 940 Length: 3 Pages Document Type: Article Critique Paper #: 58895838

This information was obtained from the facilities giving dialysis and it was for the first two months only. The study excluded darbepoetin doses as it had only been administered to a few patients. Inpatient EPO doses were not easily determinable as they are not billed differently to Medicare. The use of outpatient EPO only may be underestimating the total use of the medication. The cohort dealt with the biasness by determining the amount of time a patient stayed in hospital. The calculations on the average dose of EPO for every patient per day was by adding the total dose for a whole month then separating it by the number of days of outpatient then multiplying by 30 to get the total of a calendar month. According to the medical reports the study used the right amount of doses. The study was not randomized as it was aimed towards the African-American…… [Read More]

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Nurse Reg Regulations and Guidelines in Nursing

Words: 531 Length: 2 Pages Document Type: Essay Paper #: 4025861

Nurse eg

egulations and Guidelines in nursing

The CMS-implemented Pay-for-Performance initiatives are designed to incentivize greater quality of care by all medical practitioners for all recipients of Medicare/Medicaid services (Fenter & Lewis, 2008). The fee-for-service model that the CMS still employs on a wide basis incentivizes a lower quality of care that leads to or includes more services, which has direct detrimental effects for patients and increases the cost burden on the Medicare and Medicaid programs and thus on the federal budget and on taxpayers (Fenter & Lewis, 2008). The Joint Commission on Accreditation of Health Organizations' Core Measures are a set of guidelines meant to modernize and standardize the processes and criteria of accreditation and ongoing measurement and quality assurance at health organizations (JCAHO, 2011). These standards are also related to care, but involve licensing and accreditation rather than payment and thus work as different incentives (JCAHO, 2011).

As…… [Read More]


Fenter, T. & Lewis, S. (2008). Pay-for-Performance Initiatives. Journal of Managed Care Pharmacy 14(6): S12-5.

JCAHO. (2011). Specifications Manual for Joint Commission National Quality Core Measures. Accessed 3 April 2012.
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Heath Care Health Care Plans Health Care

Words: 988 Length: 2 Pages Document Type: Essay Paper #: 32060505

Heath Care

Health Care Plans

Health Care

Types of Health Insurance

Indemnity Insurance

This type of insurance is also known as a traditional or fee-for-service plan. The benefit of an indemnity plan is the flexibility; this plan allows members to choose any doctor or hospital. However, members must pay an annual deductible and then a percentage of each medical bill. Although these plans offer the greatest freedom to select any doctor, they are usually the most expensive option.

Typically, the member or the provider sends the bill to the insurance company. These plans usually have an annual deductible before the insurer starts paying. Once the deductible has been met most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80% of the Usual and Customary costs and the member is responsible the other 20%, known as coinsurance. If…… [Read More]


Rich, R.F. & Erb, C.T. (2005). The two faces of managed care regulations and policy-making. University of Illinois at Urbana-Champaign. Retrieved July 30, 2011, from 

"The Types of health insurance." (2011). Health insurance guide. Retrieved July 30, 2011, from
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Risk Management Issue Over the Last Several

Words: 1526 Length: 5 Pages Document Type: Essay Paper #: 42441406

Risk Management Issue

Over the last several years, the issue of patient safety has been increasingly brought to the forefront. Part of the reason for this, is because a number of high profile accidents have taken place. This has increase the chances that patient will develop complications. Evidence of this can be seen by looking no further than the most commonly reported cases involving malpractices lawsuits to include: incidents involving misdiagnosis, prescription medication errors, Obstetrics and surgery. As, these different events account for a total of: 62% of all medical malpractice cases. ("CRICO Coverage," 2011) This is significant, because it shows how the underlying risks facing many health care organizations have risen exponentially. In the case of the health organization we are studying, they have taken different steps to address these kinds of issues that they are facing. To fully understand the overall scope of their strategy requires: looking at…… [Read More]


CRICO Coverage. (2011). Harvard University. Retrieved from: 

Gray, J. (2005). Real Time Patient Safety Audits. Quality Safety Health Care, 14, 284 -- 289.

Rogers, A. (2004). The Working Hours of Hospital Staff. Health Affairs, 23 (4), 202 -- 212.

Watson, R. (2008). Improving Patient Safety. Journal of Critical Care, 23 (2), 207 -- 221.
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Graduate MSW Focus and Intentions

Words: 1171 Length: 4 Pages Document Type: Essay Paper #: 27894275

Social Work Statement of Purpose

While some people may be able to point to a distinct time or place in their lives when they knew how they wanted to make their livelihood, for others, the path to a profession cannot be mapped so precisely. My motivation to seek a Master's Social Work (MSW) degree is rooted in diverse experiences in both my personal and occupational lives.

I grew up in a family with a strong sense of community. In my extended family, some members had limited resources but they still found ways to be of help to their neighbors. When I think back to the years of my upbringing, I remember that many people in my family and community communicated their values to me, and expected me to assume a helpful stance in my life. As I grew, those expectations did too, and I learned that an aspect of my…… [Read More]

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Federal Government Healthcare Programs the

Words: 1664 Length: 5 Pages Document Type: Term Paper Paper #: 74783782

The problems facing Medicare recipients and the federal government almost seem to be overwhelming. There are proponents of a plan to privatize Social Security and health insurance, placing the onus on the individual to pay for his own health care through savings specifically for this. Some others would have the program go through the private HMOs who have, in the past, contained the costs of care by having primary care physicians manage a patient's care and purposely keeps the costs of care down.

As with Medicaid, the recipients of Medicare would have difficulty obtaining health care without this program. The recipients would most likely have no other health insurance. The trend being what it is, a lot of individuals retiring today are fortunate to have pensions from their companies, much less health benefits. ithout a national health insurance plan, like Medicare, those individuals would have to pay for health care…… [Read More]

Works Cited

Kay, Joseph. "Bush Plans renewed Assault on Medicaid." World Socialist Website. 8 Feb. 2005.

13 Aug. 2005. .

Kay, Joseph. "U.S.: States, Federal Government Prepare Massive Medicaid Cuts." World

Socialist Website. 11 May 2005. .
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Health Politics What Is the Role of

Words: 3149 Length: 10 Pages Document Type: Term Paper Paper #: 37669681

Health Politics

"What is the role of Congress in policy making process"?

Policy is a plan to identify goal or possible course of actions with administrative or management tools to accomplish these goals. n the other hand, policy is the authoritative decision made by the U.S. executive, legislative, judicial branch of government to influence the decision of others. Government is a key player in decision-making process and congress plays important roles in decision-making . In the United States, both House of Representatives and House of Senate fulfill the congressional policy responsibilities, and congress plays important role in health policy, which includes obesity prevention measures or health insurance program. Congress is an important arm of government that makes law. Important strategy that congress uses to make policy preference is by passing a bill into law. Typically, the congress could make a decision to pass or not to the policy of the…… [Read More]

Oregon Department of Human Services.(2008). The impact of federal policy on Oregon's health care reform efforts: Opportunities and barriers within Medicaid and the State Children's Health Insurance Program. Medical Assistance Programs.

Waller, M. (2005).Block Grants: Flexibility vs. Stability in Social Services. Brookings Institution Policy Brief.

Zuckert, M.P. (2002). Launching Liberalism: On Lockean Political Philosophy. Lawrence: University Press of Kansas.
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Healthcare Trends

Words: 1742 Length: 4 Pages Document Type: Term Paper Paper #: 81332878

Strategic Management of a Healthcare Facility in St. Louis

In the late 1800's and early 1900's St. Louis was a major center for automotive and other heavy manufacturing but the industrial restructuring of the Midwest during the latter half of the century has resulted in consistent economic decline of the St. Louis region. Today however as the rest of the country faces a slowing economy this region is showing new signs of growth. [Kotkin, 2002] Due to changing socio-demographics, the demand for health care and advanced medical technologies is growing consistently with a concomitant rise in health expenditure. [Zhou 2001] Health expenditure in the U.S. has risen from 7.4% of the GNP in 1970 to 15% of the GNP in 1995.[Zhou, 2001] The Health care sector deals with not only the clinical medical services, but also include methods which finance them, for e.g. insurance, benefit schemes, Medicare and Medicaid. eforms…… [Read More]


1. Kotkin, J, 2002 St. Louis: On the Way to Somewhere? Rebuz Inc.

2. Author not available, 1997, Economic Report of the President. Government Printing Office, Washington, D.C. [accessed on 4/4/03]: 

3.Author not available, 1996, Focus... Non-Elderly Missourians without Health Insurance, March 1996, Vol. 30, No. 1 [accessed on 4/4/03]:

4. Author not available, January 1999, Focus... Managed Care (MC+) in Medicaid Population, January 1999 Vol. 32, No. 11[accessed on 4/4/03] at
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Healthcare Reimbursement and Billing

Words: 1160 Length: 4 Pages Document Type: Essay Paper #: 91090578

Health Care Reimbursement and Billing

Both Mrs. Zwick and Mr. Davis face significant issues in the presented scenarios. Mrs. Zwick has multiple considerations under Medicare Parts A, B and D, in addition to her hospital-acquired urinary tract infection. Meanwhile, Mr. Davis must address the severe time constraints and costs of COBRA in light of his job termination. These two scenarios underscore current difficulties and complexities of current health care in the United States.

Discussion of Mrs. Zwick's coverage under Medicare Parts A, B and C

Medicare Part A (often called "hospital insurance") (U.S. Department of Health and Human Services, 2011, p. 15) assists in covering inpatient hospitalization and skilled nursing facilities, hospice and home health care (U.S. Department of Health and Human Services, 2011, p. 14). There is usually no monthly premium if you and/or your spouse paid Medicare taxes while employed (U.S. Department of Health and Human Services, 2011,…… [Read More]

Ethical implications of Mrs. Zwick's incurring costs related to her hospital-acquired condition are applicable despite the rehabilitation facility's exemption from POA/HAC Medicare laws. Having no first-hand knowledge of the cause of the urinary tract infection, no clear indication that I work at the rehabilitation facility and neither the privilege nor the duty of diagnosis, it would be unethical for me to tell Mrs. Zwick about my suspicions. Rather, a nurse is required to maintain his/her professional boundaries (American Nurses Association, 2001, p. 6). Simultaneously, a nurse is supposed to assure "responsible disclosure of errors" to patients and act to stop bad practices and promote best practices (American Nurses Association, 2001, p. 6). Consequently, a nurse in my position faces a dilemma: lack of personal knowledge and authority vs. my concern for the patient's well-being and constant improvement of the profession. In the face of this dilemma, I would: contact the rehabilitation facility's newly-hired nurse and advise/remind him/her of the duty to report to the appropriate supervisor and responsible disclosure to Mrs. Zwick; contact Mrs. Zwick's personal physician and explain the entire situation; direct Mrs. Zwick to discuss her health issues with her personal physician, who can review, diagnose and discuss the ramifications of her medical records, including but not limited to the urinary tract infection (American Nurses Association, 2001, p. 7). The desired outcomes would be: the rehabilitation center's absorption of Mrs. Zwick's costs related to her hospital-acquired infection through pressure exerted by its own nursing staff and Mrs. Zwick's personal physician; Mrs. Zwick's awareness of the true cause of her infection by health care providers who are directly responsible and capable.

Explain how the COBRA will allow Mr. Davis to continue his insurance coverage while he is out of work.

Due to Mr. Davis' termination from an employer of more than 20 employees, he can obtain coverage for himself, his spouse and his dependent children for up to 18 months (U.S. Department of Labor, 2012). In addition, due to his chronic cycle cell anemia, he may be entitled to an additional 11 months' extension for disability (U.S. Department of Labor, 2012). His employer is required to give a qualifying event notice to COBRA; then, COBRA sends a notice of the right to elect to continue coverage and an explanation of the steps that must be taken to continue coverage; Mr. Davis, his spouse and either or both of them in behalf of dependent children may elect for continuation of coverage
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Costs of Health Care and Quality

Words: 826 Length: 3 Pages Document Type: Essay Paper #: 58556062

Health Care Cost and Quality

The objective of this study is to examine the relationship between health care cost and quality. This study will select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care and analyze current and projected initiatives to improve quality while simultaneously controlling costs. This study will additionally conduct a synthesis of indications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.

There are many initiatives presently underway to meet the growing need of health care for a population that is greatly under-insured and many that are uninsured.

U.S. Department of Health and Human Services eport

According to the U.S. Department of Health and Human Services (2014) "Medicare is improving the way it pays for physician services. The Center for Medicare and Medicaid Innovation (Innovation Center) is exploring…… [Read More]


Advanced Practice Nursing: A New Age in Health Care (nd) American Nurses Association. Retrieved from: 

Health Care Costs (2014) Agency for Healthcare Research and Quality. Retrieved from: 

A 21st Century Health Care Workforce for the Nation (2014) U.S. Department of Health and Human Services. Retrieved from:
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Healthcare Meeting in a Recent

Words: 418 Length: 2 Pages Document Type: Term Paper Paper #: 82429961

It appears the dangers of a commercialized healthcare system have demonstrated that this beastly practice of profiting off the sick is not good for the society at many different level it contains.

Healthcare discussions of this matter do not belong in a committee that is dedicated to commercial purposes. Medicare and Medicaid were successful in the past in spite of the many governmental forces that played a role in their existence, but like all things these are old and obsolete ways of dealing with this current crisis of confusion.

A philosophical mindset, absent from this meeting, that included individual responsibility and preventative efforts to maintain health should be emphasized from leaders. Safety can never be guaranteed, neither can good health, so to offer such promises of universal coverage is over-idealistic if not criminally negligent. Like the answer to most problems, the solutions are local and come from within communities and…… [Read More]

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Johnson Administration's Great Society Initiatives Defend Your

Words: 697 Length: 2 Pages Document Type: Essay Paper #: 7174574

Johnson administration's "Great Society" initiatives? Defend your response.

As for intentions, the Johnson administration's "Great Society" initiatives should be given an A. hen he took office, Johnson saw that the country's success following orld ar II was declining and there was a potential for the country to enter a period of serious decline, a situation which ultimately did come to pass in the 1970s and again in the present period. Programs such as Medicare and Medicaid which were created during this period have continued to benefit Americans fifty years after their initial creation. However, given that much of Johnson's attention was being given to the escalation of the Vietnam ar and Johnson's encouragement of American involvement on that front, the actual effectiveness of the "Great Society" initiatives deserves a final grade of B- or C+. He was successful in getting the Civil Rights Act passed and tried to help Americans…… [Read More]

Works Cited

Harrison, B.C. & Dye, T.R. (2008). Power and Society: an Introduction to the Social Sciences.

Thomson Wadsworth.
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Reimbursement Strategies

Words: 573 Length: 2 Pages Document Type: Research Paper Paper #: 78826501

Maryland Health Service Cost Review Commission

Maryland is the only state that has a Board overseeing its inpatient commission. he Board is called the Maryland Health Service Cost Review Commission. It is a panel that regulates the rates for all hospital services in its state and requires all payers -- commercial, Medicaid, Medicare, self-pay -- to pay each hospital (regardless of status, history, and quality) the same fixed rate.

he he Health Services Cost Review Commission's (HSCRC's) statute was first enacted in 1971 and began setting hospital rates in 1974. At first, it pertained only to non-governmental care institutions, but, in time, the federal government granted it a waiver and the State was exempted from national Medicare and Medicaid reimbursement principles. Increasingly more and more, the HSCRC was granted power over setting rates for inpatient reimbursement, until it became the sole body that set the rates that payers pay for…… [Read More]

The Maryland Health Service Cost Review Commission 

Occupational Outlook Handbook, 2010-11 Edition. Medical Records and Health Information Technicians .
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Healthcare Finance a Prospective Payment

Words: 914 Length: 3 Pages Document Type: Thesis Paper #: 65027047

If the area wage index is greater than 1, the labor share equals 69.7%. The law requires the labor share to equal 62% if the area wage index is less than 1.0.

2) the wage adjusted labor share is added to the non-labor share of the standardized amount.

3) the wage adjusted standardized amount is multiplied by a relative weight for the DG. The relative weight is specific to each of 746 DG's (for fiscal year [FY] 2009) and represents the relative average cost of a beneficiary in one DG compared to another.

4) if applicable, additional amounts will be added to the IPPS payment for hospitals engaged in teaching medical residents, hospitals that treat a disproportionate share of low income patients, and for high cost outlier cases" (Acute Inpatient Prospective Payment System, 2009).

Physician services include office visits, surgical procedures, and other diagnostic services. These services are usually performed…… [Read More]


Acute Inpatient Prospective Payment System. (2009). Retrieved April 2, 2009, from Centers

for Medicare and Medicade Service Web site: MLNProducts/downloads/AcutePaymtSysfctsht.pdf" target="_blank" REL="NOFOLLOW">