discussion post response

 Edward Valencia Discussion week 3COLLAPSE
Hi Professor Kathy and Class.
The government has six health programs in the United States, although there are four that are the best known. The six programs are Medicare, Medicaid, the state children’s health insurance program (SCHIP), the department of defense TRICARE and TRICARE for life programs (DOD TRICARE), the veterans health administration program (VHA), and the Indian health program (IHS).
The government spends close to 500 billion dollars a year to maintain these programs, in which the government seeks to reduce, in the best way, diseases, injuries and destabilization in the population. The government must lead these programs to maintain a safe and quality health system for Americans.
Let’s talk about the four most essential programs such as
1. Medicare, which is a program that provides health insurance to all those over 65 who are eligible through social security or some disability, such as end-stage renal disease (ESRD). At this time approximately 60 million Americans have this benefit.
– Medicaid: (SSI) This program is given to low-income people who require medical services. As pregnant women, children and adults with severe disabilities.
– Veterans Health Administration (VHA). This program in which is a separate division in the veterans service, which was created in 1946 to provide health insurance to veterans of the armed forces of the United States that require it. Eligibility for this program is established depending on the budget you have. For this program, as it depends on the budget, priority is given to veterans with some disability that has acquired during the service or after service in the military.
– BOD Tricare: This program provides health services to active military and their dependents and retirees under 65 years of age. This program administered by the Department of Defense of the United States. (The National Academies of Science Engineering Medicine, 2002)
2. The methods of payment by insurance plans are
– URC or usual, customary and reasonable payment structure in which the amount paid depends on the geographical location, and according to what the providers charge in the area for a similar period.
– Relative Value Scale: this is a tariff program based on a scale of values, that is, it is a set of numerical values ​​associated with the medical services and procedures performed by the provider (SVR). This method reflects the number of skills and time the physician requires for the procedure.
– Resource-Based Relative Value Scale: This resource is based on a scale of values, used to determine how much the provider has to pay. This program used by Medicare and divided into three parts.
* The National Uniform Relative Unit
* A Geographic Adjustment Factor.
* A Nationally Uniform Conversion Factor.
These are the scale formula to determine the payment. “RVSi = Vi / Vn, where Vi and Vn are the value of the ith and number (nth) procedures along with some dimension.” (Buntin MB, 2003)
3. The office of the doctor must know that it is essential to confirm, as the patient will pay for the services received during the medical visit. That is why when the patient covered by insurance; it is necessary to verify the eligibility before starting the service to avoid making a claim that may not paid for the insurance. “No one plans to get sick or hurt, but most people need medical care at some health insurance covers these costs and offers many other significant benefits.”
References
Buntin MB, E. J. (2003). Payment for Physicians’ Services Under the Resource Based Relative Value Scale. NCBI.
The National Academies of Science Engineering Medicine. (2002). Overview of the Government Health Care Programs. Washington D.C: Institute of the National Academies

post 2

 Claudia Delgado Week 3 DiscussionCOLLAPSE
There are four major government sponsored insurance programs: Medicare, Medicaid, TRICARE and CHAMPVA. Medicare is an insurance program for seniors 65 and older, disabled adults, disabled children, spouses of members, or have a diagnosis of end-stage renal disease. Medicaid is targeted for the low income population, TRICARE is targeted for all military personnel and their families, and CHAMPVA is health insurance for veterans with 100 percent service related disability and their families (Sanderson, 2012). There are a few ways health plans pay physicians through a fee schedule for services provided to patients. These are usual, customary, and reasonable (UCR), relative value scale (RVS), and resource based relative value scale (RBRVS). UCR are fees established by comparing usual fees, customary fees and reasonable fees by physicians. RVS assigns a value by required skill and time, last but not least RBRVS is a relative value scale for establishing Medicare charges (Sanderson, 2012). It’s very important for physician’s offices to be educated on what their patient’s insurance cover. In that way the staff is able to properly educate the patient in return as well as avoid any billing errors.

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