Medicare Policy Implications

Paper Summary:

In this article, the writer explains that the Health Insurance for the Aged and Disabled Act (Title XVII of the Social Security Act"), also known as Medicare, was enacted to provide Americans aged 65 or older, or the disabled under the age of 65, with a comprehensive, affordable medical insurance program. In addition, the writer notes that eligibility is based on having a certain amount of past employment earnings that contributed to the Federal Insurance Contribution Act tax. The writer discusses Medicare's two separate insurance packages: coverage for hospital insurance, Part A, and coverage for supplementary medical insurance, Part B.

Outline:
Analysis of Insurance Structure and Rationale
Considerations for Goal Setting/Treatment Interventions/Discharge Planning
Reflection on Documentation Requirements/Scope of Practice/Guide to PT Practice
Moral Decision Making/Clinical Decision Making/PT Education

From the Paper:

"Treatment interventions must be described in the Intervention section of the notes, and must be appropriate to the patient's purpose of care. Successful interventions will usually demonstrate changes in the patient's condition and achievement of goals, and should be modified if they prove otherwise. Reimbursable treatment interventions must be specific to the scope of physical therapy practice, and require a qualified physical therapist to perform or guide them. Certain treatment interventions are listed as billable physical therapy interventions in the Medicare manuals, but other physical therapy related interventions would not be reimbursable if Medicare believes alternative health care professionals can execute them. Medicare also imposes limits on length of stay and number of treatment episodes, which can conflict with our ability to achieve set goals. This could conflict with our Code of Ethics, and beckons us to defend our clinical decisions and lobby for fewer restrictions (e.g. direct access)."

Sample of Sources Used:

• http://www.cms.hhs.gov/MedicaidGenInfo/
• Guide to Physical Therapy Practice, APTA. 1999.

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