Thank you both for your comments. As you have both mentioned the Medicare rule for observation is very complex and confusing. The intention of the rule is to set clinical criteria for observation‚ and rapidly discharge the patient in twenty-four hours. However‚ this does not always happen. Some observation patients can stay up to ninety-six hours before being discharged or switched to observation status. One of the problems is individual health care organization interprets the Medicare rule differently
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| Managed Care Vs Traditional Insurance | By Iris Miranda | | Iris Miranda University of Phoenix HCA 230 January 23‚ 2011 Della McMillon Presently in the United States there are several different health care plans and the decision to accept Managed Health care plans become difficult. Managed care is the most utilized form of health insurance in the United States for it provides cost that is efficient versus paying for services
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Some researchers feel that our society has unrealistically demanded the health care system to maximize quality while lowering the costs of health care services. That if we demand this change‚ there is no way we are realistically considering the cost of health care. I understand that everyone wants to receive the best therapy without paying a large amount of money. When you think about this idea‚ this plan would take time to execute. One of the cons of living in a country like the United States is
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related to the managed care organizations (Barnes et al.‚2014) Taking in to consideration the Health Maintenance Organizations (HMOs)‚ and in performance improvement programs such as pay-for-performance (P4P) and patient-centered medical homes (PCMHs). HMOs are the strongest form of managed care‚ in that they require patients to stay within the provider network and they incentivize providers to reduce unnecessary care through reimbursements and other mechanisms. Care is typically managed through the
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Managed care is any arrangement in health care in which an organization like HMO or another type of doctor-hospital network or an insurance company acts as intermediate with the individual that is seeking care and the physician. The intention of managed care is to eliminate facilities and services that are no longer needed or useful and also to reduce costs. In managed healthcare their insurance plans are very different from the fee- for-service‚ or FFS‚ insurance plans. In the
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Selection Stephanie Bennett HCS/455 December 28‚ 2012 Jonathan Bibb Medicare Medicare is a federal insurance program that was created to aid the elderly with their medical bills. The Medicare program was created 40 years ago. The original benefits under Medicare did not include drug coverage. Medicare has since added drug coverage to bridge the gap under the original available benefits. The Medicare program is facing serious financial challenges. The projected expense for medical services
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The Future of Managed Health Care Delivery System: Accountable Care Organization Veronica L Nelson MHA 628: Managed Care & Contractual Services Dr. Hwang-Ji Lu June 1‚ 2015 Abstract The health restructuring dispute has centered on compensating providers particularly more when delivering quality care to their patients than for enhancing the volume of services they provide (Ries‚ 2014) Accountable care organizations (ACOs) is a single proposed way of altering compensation methods to
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As I understood Medicaid are those personal cares services which are fundamental‚ non-acute services provided to facilitate recipients who require assistance with the activities of daily living to remain in their home or community‚ maintain their current health status and prevent‚ delay‚ or minimize deterioration of their condition. Personal care services are intended to supplement care provided by a recipient ’s family or primary caregiver‚ not replace it. Services may be provided in the home or
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health or healthcare. Examples might include policies on scope of practice for healthcare practitioners or on health insurance for children. After selecting your policy‚ locate resources to help you understand the specifics of it‚ including how its programs are organized and financed‚ how the services are delivered‚ and‚ generally‚ how well the policy has been implemented to date. Make sure to select a policy on which you can focus in some detail. If you choose to analyze the policy on insurance for
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My main point was to focus on the cons of Managed Care Organizations (MCO) and their impact on how and where nursing care is provided‚ after the implementation of the Affordable Care Act (ACA). Potter and Perry (2017) claim that the ACA will force more nurses to provide service in community-based care settings‚ potentially required to relocate or begin jobs in order to “practice in community care centers‚ schools‚ and senior centers” (p. 7). With the ACA‚ it is now the requirement of a nurse to
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