Meet with mother of this particular patient. The mother is a Caucasian disable Veteran. Mother is concerned because she can no longer afford to utilize the General Academic Pediatric Clinic (GAP) services because currently the children does not have health insurance coverage. Mother reported that Veteran Affairs does not provide health insurance coverage for her children because of an eligibly level ranking system. She reported, previously, she paid for services through making a payment arrangement in which was out-of-pocket. However, today she was informed of accountancy services that going forward all clinic visits must be paid in full as a result of a previous 3,000 balance. Mom indicated, she cannot afford to pay for visits in full. She
Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.
Also, nurses and single parents with a life changing medical condition need to read this memo because it shows how various stressors impact health outcome and leads to poor health. According to Denollet, J., et al. (2010), suggest stress leads to high blood pressure, high cholesterol, obesity, cancer and heart diseases. The stress of not being able to get child care services for her two children has significant contributed to her illness. Many parents are faced with this issue across the United States, but in Katy’s case, she has inflicted with a life changing event a terminal illness that prevents her from working and paying for child care services. Katy received a letter from her employer stating that they will no longer reimburse for child care services because of her not working. Denial of child care has contributed to the exacerbation of Katy’s symptoms and poor health outcome. Therefore, I am requesting a meeting held during this week with Katy and the Department of Social Services (DSS). The discussion will be focused on denial of child care payments and agreement for a Fair Hearing to discuss Katy’s inability to work and her limitations. According to the Legal Aid Society (2016), a fair hearing
...equired paperwork to receive the services they need (“Point: Veterans Struggle To Receive Benefits”). Soldiers are required to fill out excessive paperwork just to receive care. “Veterans and soldiers were required to file twenty-two documents to eight different departments in order to receive care” (“Point: Veterans Struggle To Receive Benefits”). It has become a very long and difficult process for our veterans to receive medical attention after returning home.
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
“Factors Affecting Health Care” (50-55) Demonstrates the sacrifices and how difficult it is for veterans to receive healthcare from the Department of Veteran Affairs.
Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...
On January 30, 2018, the Office of Inspector General’s Office (OIG) received a hotline report alleging Dr. Katrina Alexander committed abuse, fraud, mismanagement and waste against the VA by purposely lying and manipulating scheduling to receive un-deserved overtime pay, misleading providers, clerks and patients about availability in her schedule. Further, the Psychologist doubled billed for groups, misused the billing codes for psychological testing getting her higher Relative Value Units (RVU), possibly overcharging patients, then allowing her to appear as working more than any other provider. The claimant alleges that this is causing significant access issues for the Mental Health Center (MHC). Additionally, leadership at the facility permitted the Psychologist sole control of her schedule (only Mental Health provider in MHC with this permission) that led to her ability to mask the improper activity, and no action taken by the Texas Veterans Health Care System’s leadership to rectify the alleged improper activity.
Patients seek medical attention from the nursing homes. There nursing homes get a large amount of financial aid on behalf of the government. The financial assistance is given in order to ensure that all the necessary health care facilities are available at the nursing homes. There are few fraud cases that have seemed to occur in the nursing homes. One of the fraud cases that is becoming very common in nursing homes is that the patients are charged wrong amounts for the services that they acquire from the nursing home. The patient generally comes with some disease to seek medical attention. The nursing home raises fraud cases by advising unnecessary tests and procedures to be done on the patients. These tests or procedures may not be required for the patient. As the patient is limited in knowledge, the tests and procedures are done on the patient while charging the patient with a heavy amount of bill. (LLP, 2016) The nursing homes does not cater the specific problems that ha been raised by the patient rather they start to encounter on more details that are unnecessary and not even needed by the patient. The case is about a nursing home in Washington that charges heavy amounts to the patient for unnecessary treatments and procedures. (PEAR,
Counselor called Samantha on 10/10/17, after receiving her budget check-list to review all her hearing aid paperwork, discuss contribution, and draft her plan. This counselor first went over all the paperwork received from Macomb Hearing Aid Center and Dr. Aronovitz. Samantha didn’t have any questions about the paperwork. This counselor then reviewed her budget check-list with her and discussed whether she can contribute anything towards the purchase of her hearing aids. Samantha stated “as you can see from the paper, I’m pretty strapped for cash by the end of the month. At this time, I really don’t feel contribute contributing towards the cost of my hearing aids.” This counselor agreed that based on her finances she doesn’t have any money left over to contribute once she pays her bills. Samantha and this counselor also explored comparable benefits. Samantha’s insurance doesn’t cover anything towards the cost hearing aids and she doesn’t qualify for Care Credit, Lion’s Club, etc. Samantha wasn’t
the service is no longer essential to low-income adults. Instead, the cost of treatment for dental and vision is only essential to the low-income children. But, low-income adults who cannot receive tre...
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...
There are numerous amounts of billing codes within the Medicare system. Many have the same codes to one medical piece of equipment. If a biller tries to make a claim for a device, such as a wheelchair and walker, and the claim was denied based on excessive usage of that particular code because of its geographic region, then the biller can easily resubmit the claim using an alternative code that will allow the claim to go through with minor alternations to the device (AGHAEGBNO, 2001). The biller can complete this task several times until the claim is satisfied. The biller can also bill for services that were not provided in order to receive higher payments from health care providers. These are forms of multiple, double and improper billing abuses that are defrauding the system tremendously. Health care claims are coming in quickly and some payments are even expedited and reused to medical provide...
One reason health care costs are increasing are due to an increase reliance on the emergency department (ED) where many medical conditions could have been prevented or directed to a low-cost health clinic for care. Not only does this take away human capital for people who have actual medical emergencies, but also wastes hospital resources where many of these visit are billed frequently to Medicare, Medicaid, and low-cost health insurance (Choudhry et al., 2007). This problem can be attributed to people who live under the poverty line that cannot afford healthcare or qualify for Medicare and Medicaid. According to the U.S. Census Bureau’s Income, Poverty, and Health Insurance Coverage in the United States: 2012 report, the official poverty rate was at a staggering 15.0 percent, or approximately 46.5 million people are in poverty with an income of less ...
The positive impact of managed care plan to Medicaid beneficiaries is that it has the potential to improve the quality of care as managed care promises care coordination and improved attention to primary care services, both of which are largely ignored in fee-for-service systems. On the other hand, the negative impact if managed care plan to Medicaid beneficiaries occur when it is not effectively implemented and well designed. The aim of Medicaid managed care to control cost can have an adverse impact on people with disabilities, whose chronic conditions may require expensive surgeries, adaptive equipment, and ongoing or ancillary
Needless to say, all children will likely have many different health conditions during infancy and childhood. For most children these health problems are mild thus they do not interfere with their everyday lives and development (Cohen et al., 2011). The conditions come and go. Unfortunately, for some children, the chronic health conditions affect their quality of life and calls for lots of hospitalization. Children with chronic health conditions present differently. Some are well while others are ill. It is worth pausing to note that learning to live with a chronic condition can be very challenging ranging from the affected children to the family members. This paper seeks to look into the chronic illnesses in children aged between 2 and 13 years. Under this topic, the paper will give the number of children affected by the chronic illnesses, the number of those who die and the top ten major chronic illnesses affecting these children. In conclusion, the paper will give the magnitude of the problem in the medical field and the total sum of money spent of these conditions.