Medicare program

Medicare program revisions to pa3mient policies under the physician fee schedule for calendar year 2003 and inclusion of registered nurses in the personnel provision of the critical access hospital emergency services requirement for frontier areas and remote locations. Final rule with comment period. Fed Regist 2002 67 79965-80184. 

Medicare is a government-administered insurance program that is offered to people who are older than 65 years of age, have specific disabilities, or have kidney failure (DHHS, 2002a). The Centers for Medicare and Medicaid Services (CMS) oversees the Medicare program. For services provided in the outpatient setting,... 

Centers for Medicare and Medicaid Services (CMS). 2007d. Medicare Program—General Information, Medicare Part B. Available at www.cms.hhs.gov/Medicare GenInfo/03 Part%20B.asp accessed on May 2007. 

Department of Health and Human Services (DHHS), Office of the Inspector General. 2000a. Medicare program, prospective payment system for hospital outpatient services. Fed Reg 65 18433 available at www.gpoaccess. gov/fr/. 

Medicare is a federal health care program, and its recipients include people over the age of 65, the disabled, and those with end-stage renal disease. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration. The Medicare program consists of two parts (parts A and B), but is funded by four different sources (1) general tax revenues, (2) beneficiaries premiums, (3) mandatory contributions from employers and employees, and (4) deducf-ibles and copayments paid by patients. ... 

Medicaid is a federal-state entitlement program for low-income Americans who meef cerfain criferia.i Even though Medicaid is administered by CMS as well, it has very little in common with the U.S. Medicare program. Medicaid primarily covers three groups of individuals fhe elderly, the disabled, and parents and their dependent children. ... 

The Medicare and Medicaid programs have had a significant impact on the prachce of pharmacy. The Medicare program stimulated the growth of the hospital pharmacy profession. Only those hospitals with a pharmacy department that was directed by a pharmacist and met a minimum set of federal sfandards could receive federal funding for Medicare reimbursement. °... 

For fhe fufure, one of fhe greafesf concerns for fhe nafion, and always up for debafe, is fhe sfrucfure and financing of fhe Medicare program. 

With the HCQIP, there is an opportunity to restructure provider payments under the current Medicare program to emphasize the quality of care that beneficiaries receive. Medicare, as the purchaser of health care for over 39 million individuals in the U.S., has an opportunity to demand quality health care services. Quality indicators for HCQlP s six clinical areas have been developed these could serve as an early implementation phase of a new reimbursement program. 

The OIG must exclude any person or corporation convicted of a felony relating to health care fraud from the Medicare program. The law mandates minimum periods of exclusion from 1 to 3 years, depending on the basis for exclusion. For many corporations, it is this debarment from federal programs (more so than any criminal fine) that causes the most fear, as the loss of Medicare and Medicaid patients could ultimately cause the business to fail. 

Many companies, in their internal training, include information about the anti-kickback statute. The Office of the Inspector General in the Department of Health and Human Services (HHS) enforces the antikickback law. HHS administers the Medicaid and Medicare programs. Any serious violations are referred for potential criminal prosecution to the Department of Justice administrative sanctions also are possible. 

Canada uses a national health service, which provides medical services and hospital care to its entire population. The individual provincial governments operate health plans that conform to national legislation but can differ in various aspects. This Medicare program guarantees comprehensiveness, universal access, portability, and public administration. ... 

The individual provincial governments offer different supplemental benefits not covered by the national Medicare program, such as drugs, dental care, and vision care to the poor, elderly, and other specific groups. Supplemental benefits for the typical, employed, and non-elderly person come from the purchase of supplemental health insurance from private sources. ... 

The concept of home care originated in the university hospitals in the forties. In 1947 the Montefiori Hospital in New York planned to extend the hospital to the patient s home, But home care was in fact first applied in the sixties with Hospitalisation a Domicile in France in 1961. It has been implemented in a number of other countries, including the United States,Canada, and the Netherlands. " Home care coverage within the Medicare program in the United States was implemented in 1966. 

Since 1983, Medicare has paid hospitals a fixed amount per admission for a package of services based on a patient s primary diagnosis and major treatments. Medicare will now cover attendant hospital costs for patients receiving an experimental drug if the admission was not solely for the experiment. Some observers have suggested that adjustments to hospital payments allowed by Medicare to cover costs associated with medical education also underwrite some of the patient and faculty costs associated with clinical research. Medicare contractors, the companies that administer the Medicare program under contract with HCFA, interpret these policies differently in different parts of the country (395). 

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