Basic Issues in Community Based Health Care Delivery

 Introduction On July 30, 1965, President Lyndon B. Johnson signed into law the bill that led to the Medicare and Medicaid. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance). Today these 2 parts are called “Original Medicare.” Over the years, Congress has made changes to Medicare. At first, Medicaid gave medical insurance to people getting cash assistance. Today, a much larger group is covered. Case Study It is said that about 10,000 baby boomers turn 65 every day. This number will continue to increase! Most of them are qualified for Medicare. Questions 1. Explain the different parts of Medicare. 2. Your organization has received a warning from CMS that your billers do not adhere to the DRG. They quote others DRG as well to increase the bill they send to Medicare. What possible danger(s) could befall your organization? 3. Your doctors also keep their patients beyond expected stay even when they are well enough to be discharged. What are the consequences of these unnecessary elongation of stay? 4. One of your Medicare clients also requires custodial care not skilled nursing care. She refused to go home. What do you do? 5. You have been called on to correct these anomalies. What steps will you take to address them. Give reasons for every action you take.