Question

4. Define and explain Medicare and Medicaid. a. Explain how Medicare reimburses for inpatient and outpatient services. 5. Regulatory Environment of Healthcare a. Define the Stark Law and its purpose b. Define the Anti-Kickback Statute and its purpose c. Explain the intent of HIPAA d. What is anti-trust and how is it regulated 6. NEP a. What is the difference between charity care and community benefit? b. What are the 5 factors that support a hospitals 501(c)(3) tax exempt status C. What is Schedule H, when did it become mandatory and what does it help measure 7. What are the 6 types of budgets?

Answer 1

4)Medicare :- It is the federal government program that provides health care coverage for people who are 65 or older and receiving Social Security Disability Insurance (SSDI) for a certain amount of time and people with End stage Renal disease.

Medicaid:- It is the United State government program that pays for medical treatment for poor or for low income group people.

a) Medicare Part A generally covers inpatient medical services .This includes stays in hospital or nursing facility .It also pays for some home care and hospice.

Outpatient usually pay 20% of Medicare approval amount for the doctor or other health care provider services.

5) a) Stark law:- It is a set of United States federal laws that prohibit physician self referral for designated health services when a patient was covered by Medicare or another government payer.

Its purpose was to ban physician self referral for designated health services when a patient was covered by Medicare or any government payer.It represents a conflict of interest because doctor benefit from the own referral.

b)Anti kickback Statute:- It is a healthcare fraud and abuse statute that prohibits the exchange of remuneration which the statute defines broadly as any thing of value for referral for services that are payable by a federal program.

Its purpose is to protect federal health care program beneficiaries from the influence and this is intended to guard against over utilization ,increased cost and poor quality services.

C ) The main intent of HIPPA was to help ensure the continuation of health insurance coverage when an individual left his or her job.

Second intent is to ensure the security and confidentially of the patient information or data.

d) Antitrust laws are regulation that monitor the distribution of economic power in business making such that healthy competition is allowed to flourish and economies can grow.

It prohibits number of business practice that restrain trade .Example - Illegal practices of price fixing conspiracies.

6) a) Charity care is free or discounted,medically care for low income ,uninsured or underinsured patients where as community benefit includes a range of activities and services provided by hospital that are intended to improve the health of communities they serve.

b) 5 factor for tax exempt are:-

Charity care, Community benefits,Cover Medicare and Non profitable hospital ,Free service to all poor patients.

c) Schedule H is class of prescription

drugs in India appearing to drugs and cosmetic rule 1945.

7) a) Sales budget

b) Production budget

c) Financial budget

d)Overhead budget

e)Personal budget

f)Master budget