Medicaid Office Case Study

The medical office waiting room: What is a reasonable period of time to keep a patient waiting?

Per our conversation: When the provider bills an amount, we don’t always pay that billed charges. Providers tend not to change the amount they are bill with different insurances. Amerigroup pays 100% of the Medicaid Fee Schedule. The claims that your referencing below paid code 20160RT at $66.09 per the Medicaid Fee Schedule. However, code J7324 denied for authorization. I understand that authorization was waived for April, I will have this claims reprocessed. Once the auth. wavier is put in place, code J7324 pays $223.39 of the Medicaid Fee Schedule. This bring the amount of the claim to $289.48 of the $473.00 the provider is billing.

Medical: Ms. Williams failed to submit her medical documentation. Ms. Williams is expected to submit her medical evaluation or physical by 03/2017. Case Manager explained to Ms. Williams that if she failed to submit the documents required she would be considered as non-compliance.

Established in the 1930s by Henry J. Kaiser and Dr. Sidney as a health care program for construction, shipyard, and steel mill employees, in 1945 Kaiser Permanente (KP) opened enrollment to the public (Our History, 2016). Despite many challenges and setbacks, KP has grown to become one of the largest leading healthcare providers (SPEC Associates, 2011; "Labor Management," n.d.). However, is KP ready to meet the health care needs of citizens in the next decade? This paper will delve into KP to assess their readiness as well as their strategic plans regarding network growth, adequately staffing nurses, managing resources, and maintaining patient satisfaction.

On September 15, 2017, the Office of Eligibility received Ms. Heigle’s request for a State Fair Hearing, and her Medicaid coverage was reinstated pending the outcome of her appeal. The State Fair Hearing request was received in the Office of

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

Texas ranks number one with the highest uninsured rate in the nation, accounting for nearly 6 million people (1). The federal government has nearly $100 billion for Medicaid expansion, out of which $15 billion is needed for expansion in Texas (1). Opting out of Medicaid expansion has left 1.5 million eligible Texans without health insurance (2). Consequently, a 300 percent increase in costs for primary care services, being provided in the emergency department, has been observed (1). Similarly, most hospitals are facing nearly $3-5 billion in losses due to uncompensated care (1).

In the state of Texas Medicaid is funded by state and federal programs. Those eligible to receive Medicare benefit is the low income individuals, families, children, pregnant women, elderly and individuals who suffer with disabilities (Hegar). The Texas Health and Human Service commission (HHSC) distributes the Medicaid (Hegar). Those receiving Medicaid benefits in the fiscal year of 2010 were found to be 55 percent female and 77 percent under the age of 21 (Hegar). Children accounted for 66 percent of all Texas Medicaid recipients in that year; however, 32 percent of those children actually received health care (Hegar).

Case Managers have a challenging job, often dealing with patients, community agencies and facilitating their hospital discharge to the next level of care. They collaborate and communicate with the entire healthcare team and mostly with the patient during the hospitalization process. They act as support for all stakeholders to achieve positive patient outcomes. In this paper, I will be interviewing Ian Mopas, who is a Patient Care Coordinator at Kaiser Permanente in Redwood City about his education, work training, goals, and objectives as a Care Coordinator, and his responsibilities in his organization.

Medicaid expansion is seen as a huge problem in this case it takes place among the 50 states. The environment includes the 50 states such as California, Texas, New York and New Jersey. Medicaid expansion offers financial protection. It also addresses the uncompensated care problem which involves paying and reimbursement for service rendered. Medicaid expansion also provides customers access to affordable coverage, as well as customers taking up that cover, which is a moral duty of the government. Medicaid also supports politically powerful interest groups who support expansion. The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under

Following the death of a Medicaid recipient, the program not only can but must attempt to recover costs from the estate of the deceased. Medicaid's official site says:

West Florida Regional Medical Center (WFRMC) located on the north side of Pensacola, Florida competed strongly with sacred heart and Baptist hospitals for patients. WFRMC’s CEO John Kausch was an active member of the Total Quality Council of the Pensacola Area Chamber of Commerce (PATQC) (McLaughlin, C.P., Johnson, J.K., & Sollecito, 2012).. PATQC’s vision was to develop the Pensacola, Florida area into a total quality community by promoting productivity, quality and economic developments in all area organizations both public and private (McLaughlin, et, al., 2012). John

People don’t like being sick, however, some Missourians forego preventive care, required doctor visits and beneficial medicines because they cannot afford them. They may be working in part time jobs, seasonal jobs or other unskilled labor jobs and lack affordable health insurance. They are the poor people below the 138% federal poverty level (FDP). According to Chris Kelly, a former Representative of the Missouri House for district 24, the West Plains hospital Ozark Medical Center’s (OMC) service area includes more than 9,000 uninsured adults (p1). So, what do you do when you are poor and sick and can’t afford a doctor’s visit? You go to the emergency room of a local hospital and the hospital absorbs that

Immigrants that work should be allowed medical coverage when they are working for American agriculture or any American employment. They are all pulling their hours and time to boosting the American economy; therefore, it is only logical for them to have private coverage. I don’t agree that they should receive state Medicaid coverage and should be left for Americans. Medicaid should not available for them until they have been in the use over ten years.

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).