Question

oul Tolnwork assigrinelt iol weer , is to answer course materials posted. Your name and course number must be indicated on the heading of th words , de by Saturaay, Pebruary 2 at 11:55p.m 1. In chart form, compare and contrast HMOs, PPOs, and EPOs. 2. Trace the origin of DRGs and describe its system of classification. 3. Identify the similarities and differences between Medicare and Medicaid with regard to: a. Patient eligibility. b. Benefits provided. c. State and/or federal revenue sources d. Historical origins in the U.S. Submission status This assignment will accept submissions from Monday, January 28, 2019, 12:00 AM OType here to search

Answer 1

2, DRGS (Diagnostic related Group) developed by the health systems management at yale univercity with health care financing adminstration (HCFA) for the development of inpatient classification system..It is a medicare program in the united states, it measures a hospital's casemix DRGs pay flat amount per diagnosis..Every year federal government uses DRGs for 518 diagnostic payment rates for 4,800 short-term acute hospitals treating medicare eligible patients..DRGs is a patient classification system that make prospective payment to hospital with low cost initiatives. DRGs patients under diagnosis, treatment and length of hospital stay that depends upon
Primary diagnosis
secondary diagnosis
Surgical procedure performed
complications and comorbodities
patient age and sex
discharge status
3,medicare and medicaid
a, patient eligibility:
some people eligible for both medicare and medicaid ,it is called dual eligibility..If patient having both medicare and medicaid coverage, they automatically eligible for medicare savings program(MSP),medicaid program helps for cost of service that medicare does not cover..medicare coverage we can get by medicare Advance plan,for getting medicare eligibility you should be a US citizen or permanent legal resident in united states for atleast 5 years and you should be 65years or older and people of any age with end-stage renal disease..
b, Benefits provided:
Medicare consists of four parts
Part A: it covers inpatient hospital care,skilled nursing facility,hospice care and home heath service..
part B: it covers physician service, outpatient care, durable medical equipment ,home health service and preventive services..
Part c: It covers private insurance company payment for part A, B services and provide prescription drug coverage and other supplemental benefits..
part D: it covers prescription drug benefits.it also covers monthly premium,annual deductible and copayments for medicare beneficiaries who need part D coverage.
c, Medicare is administered by centers for medicare and medicaid services(CMS)..it is funded by federal payment taxes,general tax revenues and beneficiary premiums..The medicaid program run under states,along with federal minimum requirement for benefits..it take over state budgets providing expenditure and the major source of fedral revenue to states..Federal CMS monitor the state government program and meet the requirement of quality,service,eligibility and standards.
d, it was Authorized by Title XIX of the social security Act..Medicare signed into law in 1965 district of columbia and the U.S territories have medicaid program for providing health coverage for low-income people..each states has different medicaid program and it's coverage vary accordingly..

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