Essay on Wgu Task 1

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Pages: 7

Healthcare Utilization and Finance
Organizational Systems &Quality Leadership
Lynnell Fulkerson

Healthcare Utilization and Finance
A1. Medicare Part A

Medicare Part A covers medically necessary services and supplies including hospitalization

and skilled nursing facility (SNF) care. Mrs. Zwick spent five inpatient days in the hospital and

40 days in a SNF. Medicare Part A will cover 100% of the first 60 days of Mrs. Zwick’s hospital

stay after she pays the $1,184 deductible. Because Mrs. Zwick spent at least three days as an

inpatient in the hospital, and assuming that the skilled nursing facility Mrs. Zwick

is admitted to is Medicare certified, Medicare Part A will pay for 100% of her
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would not have had a UTI and her rehabilitation would have continued as expected and she

would have been discharged in the expected 21 day time frame. The infection caused her to be

weak and unable to participate in rehab setting her back and nullifying much of the progress she

had previously made. Beyond that, the SNF could not bill Medicare for the cost incurred from

the UTI. As I previously stated the cost would need to be absorbed by the SNF. In reality the

cost are absorbed by other consumers in the form of increased out-of-pocket costs such as co-


The scenario also discussed Mrs. Zwick and her daughter was not made aware the UTI was

considered to be a hospital-acquired infection. It is the responsibility of the facility to be

transparent and take responsibility for the HAI that caused a delay in Mrs. Zwick’s recovery.

Although it was not addressed in the scenario Mrs. Zwick may need to continue taking

antibiotics after discharge and the cost of that medication would not be covered by Medicare.

C. Consolidated Omnibus Budget Reconciliation Act (COBRA)

Consolidated Omnibus Budget Reconciliation Act (COBRA) allows workers and their

beneficiaries who lose their health coverage to remain insured for a limited amount of time after

the loss of coverage (Health Plans & Benefits - Continuation of Health Coverage — COBRA,

2012). Mr. Davis lost his job due to