Choose one of the following and compare its society to the feudal life of the Early Middle Ages: Clash of Clans, World of Warcraft,The Fellowship of the Ring (or the Hobbit), or the HBO series Game of Thrones. Or you may choose another comparison as long as it is science fiction or futuristic fantasy. (Do not choose a fantasy story already set in Middle Ages or in the past, or one that clearly has no common points with feudalism.)

Answer
Do not copy this assignment as it was produced by a student

Medicare and Medicaid Administration

1. Response one

An Advanced Beneficiary Notice provides the patient with an opportunity to make a decision on whether they want to receive a given service from healthcare providers, physicians, or suppliers, even though such services are likely not to be covered by Medicare (Ferenc, 2014). Some of the procedures that may be carried out on a patient or the services that may be offered are deemed to be medically unnecessary by Medicare, hence their cost is not covered. In such a case, presentation of the ABN to the patient presents the patient with three major options. The first option allows the patient to pay for the known cost of the procedure or service but still request Medicare to be billed. In case Medicare pays for the MRI procedure, the provider will refund the patient the money. This option also allows the patient a chance to appeal if Medicare fails to pay for the process. The second option would involve the patient taking on the cost of the MRI by himself directly from his pocket or via an insurer without Medicare being billed. The third option involves the patient refusing to take the procedure (Ferenc, 2014). This will protect the patient from any charges that may emanate from such a procedure.

2. Response two

During the verification of Medicare eligibility, there are four main steps that the registrar at the hospital’s front desk has to keep in mind. The first step involves checking the patient’s demographics to ensure that they are correct and up to date (Green, 2016). The registrar should ensure that the data entered correctly reflects that on the ID card. This step is important in ensuring that the billing is done on the correct patient and that the patient is easily identified by Medicare upon billing. The second step involves checking if the procedure or the service that the patient is seeking is covered by Medicare using the Medicare criteria. It is at this point that a patient will be provided with an ABN if the registrar believes that Medicare may not cover the service (Ferenc, 2014). This step is important in ensuring that the patient is aware of the fact that they may have to pay for the services with which they are being provided. It is only the patient who can carry forth with the decision to receive the services or not based on their ability to pay for them if not covered. The third step involves verifying the patients Medicare benefits. There are various websites on which one can check the patients Medicare benefits. This is important in ensuring that the patient is still actively covered by Medicare. The last step involves communicating with the patient and making them understand the financial responsibility that they are likely to take up from the whole process where applicable or whether their services will automatically be compensated by Medicare (Diamond, 2012). This is meant to ensure that the patients make an informed decision in proceeding with the services.

3. Response three

For claims that have been denied by Medicaid due to the need for prior authorization, the healthcare provider need to submit a prior authorization request providing all the necessary supporting documents (Diamond, 2012). The provider should indicate the request as a retroactive request on the Prior Authorization Request Form, and explain why so in the section requiring Summary of History. In this case, the healthcare provider cannot bill the patient since the responsibility of seeking authorization for the process lies with the provider as opposed to the patient (Green, 2016).

References

Diamond, M. S. (2012). Understanding Hospital Coding and Billing: A Worktext. Clifton Park, NY: Delmar Cengage Learning.

Ferenc, D. P. (2014). Understanding Hospital Billing and Coding. St. Louis, Missouri: Elsevier Saunders.

Green, M. A. (2016). Understanding Health Insurance: A Guide to Billing and Reimbursement. Boston, MA: Cengage Learning.