Define and discuss the Medicare private contract.
Define and discuss: Adverse Selection and Favorable Selection What implications does Adverse Selection have on Medicare, the private individual market, the employer-sponsored market, consumer directed health plans, and even the ACA?
Discuss the history of Medicare and compare and contrast Medicare Part A vs. Medicare Part B
Explain Private Insurance, Medicare Insurance, and Medicaid Insurance
Define: 1. What is Medicare Advantage? 2. What is a benefit period for Medicare? 3. Describe the 80/20 co-payment for Medicare and Medicare Advantage? 4. What is the Plan of Correction? 5. What is a deficiency? 6. What is Nursing Home Compare? 7. Describe the role of the Ombudsman? 8. Define Resident Rights? 9. What are the three therapy categories? 10. Describe Quality of Care?
Think of a contract as a private set of laws that only apply to the two parties who signed it. Those two parties have determined and agreed to the subject, consideration, timing, duration, etc. for the contract. Generally, the court does not interfere with the parties’ agreement, except in certain circumstances (e.g. if the subject of the contract violates public policy). When a contract is breached and a lawsuit is filed, the court will generally award compensatory damages that make...
Think of a contract as a private set of laws that only apply to the two parties who signed it. Those two parties have determined and agreed to the subject, consideration, timing, duration, etc. for the contract. Generally, the court does not interfere with the parties’ agreement, except in certain circumstances (e.g. if the subject of the contract violates public policy). When a contract is breached and a lawsuit is filed, the court will generally award compensatory damages that make...
Please define this words in your own words!
Medicare Severity Diagnosis-Related Groups Case Rates and Package Pricing Capitation of Percentage of Revenue Contract Capitation Periodic Interim Payments and Cash Advances Package Pricing or Bundled Charges Ancillary Services Network Maintenance
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...
Should congress pay more emphasis on Medicare fee-for outcomes payments and reduce private health plan's role in Medicare?
Discuss the following – What feature(s) of Medicare would cause an economist to say that “Medicare stinks as insurance”? Medicare supplement insurance is available from the commercial market and most commonly covers ‘up-front’ deductibles and least commonly covers “high-end” risks. Does this model of coverage afford well or poorly with the model of demand for insurance ? What should we conclude from this?