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Medicare Reimbursement Author: Date: Scenario 1 Medicare is an insurance provided by government to cover supplies and the services that are needed for the treatment of a medical condition (Medicare, 2013). Mrs. Zwick has Medicare part A, B, and D. Since Mrs…
Part A will cover the inpatient expenditures of Mrs. Zwick since she was in SNF a whole of 40 days. Part A covers full expenses for SNF for the first 20 days and after that it requires the policy holder to pay $148/ day up to 100 days. Part B will cover the equipment charges for the patient. Under the DME (Durable Medical Equipment), the walker that has been prescribed for Mrs. Zwick, will be paid for by Medicare. Mrs. Zwick will have to pay 20% of the amount that has been approved by Medicare, whether she chooses to rent it or purchase it. Part D will cover the drugs that have been prescribed by the doctor under the Medicare Prescription Drug Plan (PDPs). Mrs. Zwick has authorization that these drugs are medically necessary for her, but she will need to ascertain the quantity of the drugs. Step therapy will be applied to see if similar low cost drugs will be effective in the treatment, only then will Plan D cover the prescription drugs. The actual cost will depend n the type of drug used. Since Mrs. ...
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