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Medicare Explained has been prepared for Medicare beneficiaries and others who need a relatively thorough explanation of the Medicare program with particular emphasis on services covered in institutional settings and services provided by physicians and suppliers. Medicare Explained includes: Analysis of legislative, regulatory, and agency guidance issuance on available benefit. Medicare coverage and exclusions. The administration of the Medicare program. Medicare payment rules under Parts A, B, C, and D. Details on the process for submitting beneficiary claims as well as the appeals process.
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
On July 30, 1965, President Johnson flew to Independence, Missouri to sign the Medicare bill. The new statute included two related insurance programs to finance substantial portions of the hospital and physician expenses incurred by Americans over the age of sixty-five. Public attempts to improve American health standards have typically precipitated bitter debate, even as the issue has shifted from the professional and legal status of physicians to the availability of hospital care and public health programs. In The Politics of Medicare, Marmor helps the reader understand Medicare's origins, and he interprets the history of the program and explores what happened to Medicare politically as it turned from a legislative act in the mid-1960s to a major program of American government in the three decades since. This is a vibrant study of an important piece of legislation that asks and answers several questions: How could the American political system yield a policy that simultaneously appeased anti-governmental biases and used the federal government to provide a major entitlement? How was the American Medical Association legally overcome yet placated enough to participate in the program? And how did the Medicare law emerge so enlarged from earlier proposals that themselves had caused so much controversy?
Since the last edition of Medicare Law was published, the rules that govern Medicare have been changed substantially, with many of those changes being driven by the Affordable Care Act. The program structure has been altered somewhat, with the addition of new types of government contractors. From a coverage perspective, there are a number of new benefits available as well as new coverage rules. There are several new or modified payments systems that have been put into place. In addition, Medicare has tied its reimbursement rules much more closely to the quality of the services delivered than ever before, with significant reporting requirements now in place. The billing rules have been modified, including new time limits on the filing of claims, and the fraud and abuse rules have been strengthened. Finally, there are new payment approaches, such as Accountable Care Organizations, that are being or have been introduced. In short, our current Medicare system and its governing rules are quite different from those that were discussed in the last edition.The American Health Lawyers Association is pleased to bring you the Third Edition of Medicare Law. Our tremendous thanks go to Editor-in-Chief Thomas W. Coons and author experts Rodney A. Johnson, Emily Jane Cook, John R. Hellow, David W. Hilgers, Elizabeth T. Thomas, Matthew Philip Utecht, Kathleen Ann Peterson, Anne W. Hance, Gary Scott Davis, Adam J. Rogers, Donald H. Romano, Robert L. Roth, William T. Mathias, and James F. Flynn. Their work, like that of the previous author Terry Coleman, leads you through the Medicare maze, from a discussion about the program's structure, to the critically important aspects of benefits, coverage, and eligibility.Coverage includes in depth examination and discussion of:Payment for hospital services, including PPS and PPS-exempt hospitalsHospital payment methodsThe DRG systemThe urban/rural distinctionsOutlier paymentsThe physician fee scheduleCost reimbursementProhibited acts under the Anti-Kickback and Stark LawsAdministrative and judicial appeals processes; andThe new incentive payment programsThis is the road map to a thorough understanding of Medicare, whether you are just beginning the journey or are continuing to learn about this complex and important aspect of healthcare law. Best of all, it is organized to facilitate an understanding of the program and provides citations to the underlying portions of the statute, regulations and manuals.The eBook versions of this title feature links to Lexis Advance for further legal research options.
The One Resource That Explains EVERY Provision of the Single Most Sweeping Piece of Legislation in 50 Years! CCH's Law, Explanation and Analysis of the Patient Protection and Affordable Care Act, Including Reconciliation Act Impact provides employers, legal, legislative, health, and insurance professionals with comprehensive explanation and analysis of every aspect of health care reform legislation. The information is crucial, current, and reliable and offers complete, clear and practical guidance on every provision. This is one of the most high-impact pieces of legislation passed in decades. Taken together, the laws are over 2,800 pages long. Many hundreds of changes are made to existing laws and– over 600 changes to the Social Security Act alone (which contains all of the Medicare and Medicaid law), including almost 50 newly added provisions. Other laws affected include the Employee Retirement Income and Security Act (ERISA), the Public Health Service Act, the Internal Revenue Code, and even the Fair Labor Standards Act, among others. Law, Explanation and Analysis of the Patient Protection and Affordable Care Act, Including Reconciliation Act Impact include contains almost 500 expert explanations telling you what all those law changes mean. Only Law, Explanation and Analysis of the Patient Protection and Affordable Care Act, Including Reconciliation Act Impact includes: An editorially enhanced version of the Patient Protection and Affordable Care Act that integrates in place changes made to it by the Reconciliation Act of 2010 and Title X amendments Text of the Joint Committee on Taxation report that provides background information on the revenue-related provisions of the laws Finding devices to help navigate between analysis and official text Caution notes The legislation contains the most significant health care changes in decades. Topics covered include the following: For employers: Enhanced employer responsibility Insurance market reforms Health insurance exchanges Individual responsibility mandate For health providers and beneficiaries: Expanded eligibility rules for Medicaid and the Children's Health Insurance Program Reimbursement changes for physicians and hospitals to focus on primary and preventive care Reimbursement changes for hospitals to increase coverage in rural areas Expansion of existing value-based purchasing and quality programs EXCLUSIVE ONLINE FEATURE! With your purchase of the book, you'll receive access to a special website that gives you access to SSA, ERISA, and IRC provisions amended by the Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, as well as other valuable Health Care Reform information and resources. Full text of both Acts will also be provided on this exclusive website.