ASSIGNMENT

Assignment



Scenario 1

Part A.

Mrs. Zwick is eligible for Medicare Part A, Part B, and Part D. Medicare Part A covers partial amount of hospital stay expenses if a patient stays at least overnight. So Mrs. Zwick was eligible for that (Medicare, 2011). Since she stayed for more than three days, she also became eligible for skilled nursing facility for max for 100 days. According to the policy, first 20 days will be covered fully by Medicare. All additional stay exceeding 20 days at Skilled nursing facility will require a copayment of $141.50 per day. Mrs. Zwick's stayed for a total of 40 days even though projected stay was 21 days only. Medicare will only cover the expected days at SNF, because hospital-acquired urinary tract infection caused further stay, which is not covered, under it. So she is only liable to pay $141.50 for one day. Next 19 days, Hospital will take care of all because the infection could have been prevented provided there were appropriate measures in place.

Medicare B cover expenses after the Mrs. Zwick becomes outpatient and requires certain services and durable medical equipment (Medicare, 2011). She automatically became eligible for Medicare B after being hospitalized as it is her medical insurance. It covered those expenses that are not covered under Medicare A. In case of Mrs. Zwick, service consists of all subsequent treatments as an outpatient which might be needed in the course of full recovery. Services and DME include laboratory tests, vaccinations expenses, and medication administration. The walker prescribed to Mrs. Zwick also comes with Medicare B. Under this package, she will only be paying only 20% while the remaining 80% approved services will be covered by Medicare B (Medicare, 2011).

Medicare (Medicare Prescription Drug Coverage) D is additional coverage package under the Medicare Prescription Drug, Improvement, and Modernization Act that allows Medicare to cover a list of drugs prescribed to patients. This patient may or may not include all drugs and medicines; it some cases it only covers to cost for a certain period. Since Mrs. Zwick is eligible for Medicare D, cost of prescribed medications will be covered.

Part B.

Mrs. Zwick was sent to Skilled Nursing Facility for a period of 21 days. It was expected that she would recover during this rehabilitation period. During the course, she got the hospital-acquired infection i.e., urinary tract infection. In accordance to the policies laid down by CMS for Medicare a coverage package, no hospital acquired infection will be covered. The infection caused Mrs. Zwick to stay an additional period of 19 days.

Here, certain important ethical questions are raised. Even though, hospital is going to bear all HAC expenses for now, but what happens upon discharge? Will Mrs. Zwick reliably cured, and free from any further complication and financial obligation arising out of the HAC. It might linger on upon discharge leading to further sequelae in future. The facility was not following the current evidence-based protocol related to urinary catheter care which is required by ...