Healthcare Reimbursement and Billing Essay

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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, p. 28). However, if you have to buy Part A, you will have to pay up to $451 per month (U.S. Department of Health and Human Services, 2011, p. 28). Medicare Part A will cover Mrs. Zwick's 5-day inpatient hospital stay, including her semi-private room, general nursing, meals, and miscellaneous services and supplies provided by the hospital (Medicare Consumer Guide, 2012). She will pay a deductible of $1,156 and no copayment because this is within days 1 -- 60 of her benefit period (U.S. Department of Health and Human Services, 2011, p. 34). The skilled nursing home for rehabilitation is also covered because it is deemed medically necessary after more than 3 days of medically necessary inpatient hospital stay (U.S. Department of Health and Human Services, 2011, p. 35). In addition, according to the 21-day projected stay she would pay only $144.

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50 for the 21st day, as she pays nothing for the first 20 days (U.S. Department of Health and Human Services, 2011, p. 35). As the case facts indicate, she was sick 10 days into her stay and could not participate for a full week, or 7 days. Since she stayed total 40 days, on the face of it, she would have to pay $144.50 per day for 20 days, totaling $2,890.00 (U.S. Department of Health and Human Services, 2011, p. 35).

Medicare Part B, (often called "medical insurance") (U.S. Department of Health and Human Services, 2011, p. 15), generally assists in coverage for services of doctors and other health care providers, outpatient, durable medical equipment and home health care (U.S. Department of Health and Human Services, 2011, p. 14). For this coverage, Mrs. Zwick pays a monthly premium of $99.90 (U.S. Department of Health and Human Services, 2011, p. 29). Part B will cover her doctor's bills (U.S. Department of Health and Human Services, 2011, p. 36) and the walker she received upon discharge because it is durable medical equipment. For this coverage, she must pay a deductible of $140.00, and then she will pay 20% of Medicare's approved amount for the service (U.S. Department of Health and Human Services, 2011, p. 36).

Medicare Part D (often called "prescription drug coverage") (U.S. Department of Health and Human Services, 2011, p. 14), has variable premiums and generally requires the covered individuals to pay 20% of Medicare-approved drug costs (U.S. Department of Health and Human Services, 2011, p. 48). Part D will cover Mrs. Zwick's lab tests, prescription/IV drugs during hospitalization (U.S. Department of Health.....

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