Question

WRITTEN ASSIGNMENT DUE DATE APRIL 4, 2019 Identify the percentage of the U. S. Gross Domestic Product (GDP) dedicated to Health Care. Explain the concept of cost sharing in health insurance. Why is this important Discuss how physicians are paid when caring for Medicare patients? Do you think this is an effective system? Why or why not? Define the following: . Accountable Care Organization 2. Balanced Billing 3. Usual, customary and reasonable (UCR) Describe the benefits of group insurance. Describe the benefits of a consumer driven Health Plan (CDHP) Why are Medicare supplemental plans important? Describe the Triple Aim

Answer 1

*Gross Domestic Product in health care is defined as the total value of goods produced and services provided in a country for health care during one year

According to The National Health Expenditure Accounts (NHEA) U.S., health care spending grew 3.9 per cent in 2017, reaching $3.5 trillion or $10,739 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.9 per cent.

* Cost sharing means that insured individuals will pay a portion of their health care costs. When the insured assumes at least part of the risk. It lowers utilization without a negative impact on health. Forms of cost-sharing are Premiums, Deductibles and Copayments.

It is designed to reduce the utilization of unnecessary health care services and increase the cost-consciousness of consumers,

*Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare and are typically less than the amount billed or the amount that a private insurance company would pay.

Medicare Part A and B claims are submitted directly to Medicare by your providers (doctors, hospitals, labs, suppliers, etc.). Medicare takes approximately 30 days to process each claim.

Medicare pays Part A claims (inpatient hospital care, inpatient skilled nursing facility care, skilled home health care and hospice care) directly to the facility or agency that provides the care. The client is responsible for deductibles, copayments and non-covered services.

Medicare pays Part B claims (doctors’ services, outpatient hospital care, outpatient physical and speech therapy, certain home health care, ambulance services, medical supplies and equipment) either to provider or you.

This is effective because it is a mutual assignment between the provider and the client.

* Accountable care organizations are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The main goal of an accountable care organization is to ensure that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.

* Balance billing is a practice in which doctors or other health care providers bill you for charges that exceed the amount that will be reimbursed by Medicare for a particular service.

* UCR - Usual, Customary and reasonable define covered expenses as charges for the services and supplies :

• Those that are medically necessary for the treatment or diagnosis of an injury or illness
• Those that are ordered or prescribed by a licensed provider
• Those that do not exceed the UCR fee generally charged by like providers in the same geographic area for the same procedure

* Consumer Driven Health Plan (CDHP) combines a health account with traditional health coverage includes a spending account available to the consumer(s) to spend on their routine health care

• Allows consumers to use their health accounts to help pay for their out-of-pocket health care costs
• Offers programs and healthy rewards so consumers can learn about their health care options and costs associated with their health care needs

*A Medicare supplement plan has always been a wise investment for ageing adults to help bridge the gap between what original Medicare plans pay and what they don't, such as deductibles, copayments, and coinsurance.

*Triple Aim:

Improving the US health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.